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Background: Cerebral echinococcosis is relatively rare, and it is important to distinguish cerebral cystic echinococcosis (CCE) from cerebral alveolar echinococcosis (CAE) in terms of pathological diagnosis. We aim to describe the different clinicopathological features among patients with CCE and CAE., Methods: We collected 27 cases of cerebral echinococcosis which were diagnosed in the Department of Pathology of the First Affiliated Hospital of Xinjiang Medical University from January 1, 2012, to June 30, 2023. We compared the patients' clinical characteristics, MRI features, and pathologic manifestations of CCE and CAE., Results: Among 27 cases of cerebral echinococcosis, 23 cases were CAE and 4 cases were CCE. The clinical manifestations of both CCE and CAE patients mainly included headache (21 patients, 77.78%), limb movement disorders (6 patients, 22.22%), epileptic seizures (4 patients, 14.81%) and visual disturbances (2 patients, 7.41%). The average onset age of CAE cases was 34.96 ± 11.11 years, which was 9.00 ± 7.26 years in CCE cases. All CAE patients presented with multiple involvements in the brain and extracranial organs while all CCE patients observed a solitary lesion in the brain and 3 CCE cases had no extracranial involvement. Lesions of CCE in MRI showed a single isolated circular, which was well demarcated from the surrounding tissues and with no obvious edema around the lesions, whereas CAE lesions presented as multiple intracranial lesions, with blurred edges and edema around the lesions, and multiple small vesicles could be observed in the lesions. The edge of CAE lesions could be enhanced, while CCE lesions have no obvious enhancement. CCE foci were clear cysts with a wall of about 0.1 cm. Microscopically, the walls of the cysts were characterized by an eosinophilic keratin layer, which was flanked on one side by basophilic germinal lamina cells, which were sometimes visible as protocephalic nodes. While the CAE lesion was a nodular structure with a rough and uneven nodule surface, and the cut section was cystic and solid; microscopically, the CAE lesion had areas of coagulative necrosis, and the proto-cephalic nodes were barely visible. Inflammatory cell areas consisting of macrophages, lymphocytes, epithelioid cells, plasma cells, eosinophils, and fibroblasts can be seen around the lesion. Brain tissues in the vicinity of the inflammatory cell areas may show apoptosis, degeneration, necrosis, and cellular edema, while brain tissues a little farther away from the lesion show a normal morphology., Conclusions: With the low incidence of brain echinococcosis, the diagnosis of echinococcosis and the differential diagnosis of CAE and CCE are challenging for pathologists. Grasping the different clinical pathology characteristics of CAE and CCE is helpful for pathologists to make accurate diagnoses., (© 2024. The Author(s).)

Cerebral sparganosis is a severe parasitic infection caused by the larvae of Spirometra mansoni. We retrospectively reviewed the clinical data of 26 patients with cerebral sparganosis diagnosed in our center and reviewed the literature on cerebral sparganosis in mainland China. Among our 26 patients, 20 suffered from seizures, 11 had limb weakness and 11 experienced headaches. The characteristic MRI features included ring-like enhancement in 24 patients, tunnel lesions in 14 patients and lesion migration in seven patients. Twenty-three patients underwent surgery, with the brain tissues of all patients revealling many inflammatory tunnels. Inside these tunnels, live or degenerate larvae were identified in 20 patients, but only eosinophilic tunnels were identified in the three remaining patients. All patients in this series received praziquantel, with three patients receiving praziquantel alone, with no surgical intervention, and all had a favorable outcome on long term follow-up. At least 82 patients with cerebral sparganosis with histo pathological confirmation have been reported in mainland China. The clinical course, radiological features, and pathological features of mainland Chinese patients were mostly similar to those reported in other regions. There exists an inherent correlation between radiological features and pathological changes, with worm migration causing multiple inflammatory tunnels, especially eosinophilic tunnels, which thus form the basis of tunnel-like or ring-like enhancement on multi-planar MRI, and might be predictors for a poor prognosis. Surgical therapy is optimal in the treatment for cerebral sparganosis, but medication (praziquantel and dexamethasone) has achieved favorable outcomes in some patients., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Purpose: We reviewed the clinical and follow-up data of 89 cases with cerebral paragonimiasis and summarized the disease characteristics, diagnostic strategies and treatment experience, with an expectation of establishing standard diagnosis and treatment for cerebral paragonimiasis., Methods: A total of 89 cases (age: 2-64 years) of cerebral paragonimiasis admitted and treated in our hospital in the past 10 years were included in this study. The clinical symptoms were manifested by headache, epilepsy, paralysis, etc. In order to confirm the diagnosis, we performed imaging examinations (e.g., CT and MRI) and laboratory tests (ELISA and eosinophil counting). Seventy-two patients received oral administration of praziquantel only, 16 cases received surgical resection of the lesions and 33 cases received appropriate anti-epileptic therapies. The diagnostic, treatment and follow-up data were statistically analyzed., Results: Follow-up was performed for 73 cases for a period of 6-48 months and the original symptoms were markedly improved without recurrence. 15 patients were lost to follow-up after discharge. One patient died of epilepticus insult, high fever and convulsions. Although 4 patients still had seizures within 6 months of treatment, seizure frequency was significantly reduced. Histopathological evaluation demonstrated inflammatory changes with esoinophilic infiltration in all 16 patients who underwent surgical resection., Conclusions: Young patients (age: <18 years) are more likely to have cerebral hemorrhage. SWI imaging contributes to the diagnosis of hemorrhagic lesions. Cerebral paragonimiasis can cause epilepsy, especially grand mal seizures., (Copyright © 2012 Elsevier B.V. All rights reserved.)

The diagnosis and treatment of one case of cerebral sparganosis suggests that stereotactic positioning operation is an effective treatment, and understanding of the spectrum of parasitic diseases is helpful for the diagnosis and differential diagnosis. However, in non-epidemic area of sparganosis, the classical epidemiological route of transmission is difficult to satisfy the explanation of the current status of the disease.

We analysed the magnetic resonance imaging (MRI) clinical characteristics as well as serum and cerebrospinal fluid (CSF) immunoassay results in 41 patients with cerebral schistosomiasis. Thirty-five cerebral schistosomiasis patients were diagnosed by imaging and immunoassay, five by post-operative pathological examination and one by diagnostic treatment with praziquantel. We found that MRI showed specific enhancement, forming the 'Buddha's hand' appearance. Although this pattern of MRI enhancement may not be present in all cases of cerebral schistosomiasis, when it is observed a diagnosis of cerebral schistosomiasis should be considered. Meanwhile, CSF immunoassay may also play an important role in the differential diagnosis of cerebral schistosomiasis.

Objective: To explore the risk factors of cerebral schistosomiasis japonica., Methods: A total of 37 confirmed cases, diagnosed during 1999-2004 in Anhui Province, were involved in the study as case group. Three controls for each case were selected from the general population either without schistosomiasis, with chronic schistosomiasis or with acute schistosomiasis. The relevant risk factors on the disease were analyzed., Results: Four factors with labour intensity, physical, economical and nutritional conditions before illness between case group and normal control group, 7 factors including epilepsy history, hypersensitivity, intensity and times of infection between case group and acute schistosomiasis control group, 10 factors including intensity of infection, times of infection and treatment between case group and chronic schistosomiasis control group, all showed statistical significance (p < 0.05) . Five factors showed statistical significance (p < 0.05) between case group and the 3 control groups., Conclusion: The intensity of schistosome infection and treatment history are the main risk factors for cerebral schistosomiasis, and the physical and psychosocial conditions of the patients show some effect on the disease.

Purpose: To study the surgical treatment of epilepsy with cerebral granuloma caused by Schistosoma japonicum., Methods: Two hundred fifty cases of epilepsy caused by cerebral schistosomiasis from 1955 to 2004 were analyzed retrospectively., Results: There were no deaths. Follow-up of 196 cases for 4-5 years after operation demonstrated that 180 cases (92%) were seizure-free or well-controlled., Conclusions: Surgical treatment should be considered when drug therapy fails to control epilepsy or the lesion shows mass effect. Intraoperative electrocorticography monitoring is helpful to define the extent of the resection of the lesion.