Cerebral sparganosis

The Editor — Sir,

I read the recent publication on cerebral sparganosis by Chiu et al [1] with great interest. The authors reported on the magnetic resonance (MR) spectroscopy and perfusion character of this neurological disorder. This neurological parasitic infestation is extremely rare [2] and there is still no clear conclusion on the clinical usefulness of neuroimaging for its diagnosis. Indeed, in a large case series of sparganosis from Thailand, the final diagnosis of cerebral sparganosis was not obtained from neuroimaging [2]. The mass lesion demonstrated by MR imaging did not bring any conclusive diagnosis and removal of granuloma from the identified pathological site was necessary to obtain the final definitive diagnosis by parasitological examination [2, 3].

In the endemic area of sparganosis, where other neurological parasitic infestations (e.g. cysticercosis and gnathostomiasis) are also common, the clinical usefulness of MR imaging is very limited in providing a definitive diagnosis of cerebral sparganosis. A history of risky behaviour (e.g. drinking impure water, eating frog or snake meat, or using frog or snake meat as a poultice) might be a clue and offers supporting evidence for a presumptive diagnosis in cases of abnormal brain MR imaging results [2].