TABLE 5.

Central nervous system electroencephalogram, imaging, and biopsy/autopsy results for 25 reported cases of Baylisascaris procyonis neural and visceral larva migrans^a

Patient no./yrb/sex/age/location	EEG result	CNS imaging result	CNS imaging follow-up result (time interval)	Biopsy/autopsy result	Larva identified (size)	Reference(s)
1/1973/F/18 mos/Missouri	Normal	Radionuclide brain scans normal	NR	ND	ND	5, 7, 8, 13
2/1980/M/10 mos/Pennsylvania	NR	CT: severe periventricular encephalitis, acute hydrocephalus	CT: cerebral atrophy, resolution of periventricular enhancement	Autopsy: systemic larva migrans with severe brain involvement	B. procyonis, 1 mm × 60-μm diam	5–8, 34
3/1984/M/18 mos/Illinois	Abnormal—diffuse slowing	CT: marked periventricular enhancement and ventricular dilatation	NR	Autopsy: systemic larva migrans with severe brain involvement; 3 larvae/g of brain	B. procyonis, 1.5–1.9 mm × 60–74-μm diam	5–8, 35
4/∼1985/M/21 yrs/Oregon	NR	Large right frontoparietal lesion	CT, MRI (20 yrs): diffuse cerebral and cerebellar atrophy, mixed porencephaly and gliotic changes in cerebrum, and right ventricular dilatation	Biopsy: characteristic malacic and inflammatory lesions present	NR	5, 6, 7, 33; K. D. Thomson, unpublished data and written communication to K. R. Kazacos (2005, 2010)
5/1990/M/13 mos/New York	Normal (2 occasions)	CT, MRI normal	MRI (6 mos): diffuse brain atrophy with selective loss of white matter and progressive CSF space enlargement	ND	ND	5–8, 33
6/1993/M/13 mos/California	Normal	MRI: bilateral, patchy T2 hyperintensity of white matter in periventricular regions and deep cerebellum	MRI (6 weeks): progressive, increasingly confluent white matter changes throughout supratentorial regions and tegmentum of brain stem, with diffuse atrophy	Biopsy: positive; subcortical white matter granuloma with larva	B. procyonis, 36–40-μm diam, posterior intestinal region	5–8, 36
7/1993/M/9 mos/Michigan	Abnormal—diffuse slowing	CT, MRI normal	MRI (17 days): Increased T2 signal bilaterally in deep cerebral white matter, especially corona radiata, focally in cerebellum; increased prominence of ventricles and sulci; minimal cerebral atrophy	ND	ND	5, 6, 8: J. M. Proos and C. Gushurst, unpublished data (1993) and written communication to K. R. Kazacos (1993–1994)
8/∼1994/M/10 yrs/Massachusetts	NR	NR	NR	Autopsy: large nodular eosinophilic cardiac pseudotumor with larva in left ventricle	B. procyonis, 60–70-μm diam	5, 7, 8, 37
9/1996/M/6 yrs/Illinois	NR	ND initially (3.5 yrs prior)	MRI (post-3.5 yrs): active demyelination in deep periventricular white matter, with diffuse cortical atrophy	ND	ND	5–8, 38
10/1996/M/13 mos/Minnesota	Abnormal—diffuse slowing	CT: normal; MRI: iron deposition and early white matter changes	MRI (4 weeks): progressive abnormalities with severe cortical atrophy and diffuse white matter degeneration	ND	ND	5–8, 39
11/1997/M/19 mos/Minnesota	NR	MRI: minor white matter changes	MRI (60 days): ongoing severe white matter loss and cortical atrophy	ND	ND	5–8, 39
12/1998/M/11 mos/California	Abnormal—diffuse slowing	MRI: small foci of enhancement in left temporal and periventricular regions and overall patchy white matter abnormalities and demyelination	MRI (10 days): marked progression of white matter abnormalities	ND	ND	5–8, 40
13/2000/M/2.5 yrs/Illinois	Abnormal—diffuse slow waves	CT: initially normal and then increased signal involving both cerebellar hemispheres	MRI (2 mos): progressive cerebellar and supratentorial white matter demyelination and diffuse cortical atrophy	ND	ND	5–8, 38, 41
14/2000/M/17 yrs/California	Abnormal—diffuse encephalopathy	CT: initially normal; MRI: deep white matter abnormalities in dentate nuclei of cerebellum bilaterally	MRI (11 days): additional lesions in bifrontal, left temporal, and parietal white matter	Biopsy: focal patchy necrosis in gray matter with perivascular infiltrates of macrophages, plasma cells, and eosinophils; positive for larva	B. procyonis	5–8, 41; W. A. Kennedy, unpublished data (2001) and written communication to K. R. Kazacos (2001)
15/2002/M/11 mos/California	Normal	CT and MRI: ventricular dilatation	MRI (14 days): diffuse cerebral atrophy and T2 signal enhancement, marked volume loss, eventually stabilizing with a decrease in inflammation	ND	ND	5–8; K. R. Kazacos, unpublished data (2002–2004); D. Paul, unpublished data (2003) and written communication to K. R. Kazacos (2003)
16/2004/M/4 yrs/Louisiana	NR	MRI: cerebellar edema	MRI (12 days): improvement of cerebellar edema	ND	ND	42
17/2004/F/15 mos/New York	NR	MRI: multiple scattered foci of hyperintensity and edema along cortex-white matter junction	MRI (9 weeks): extensive periventricular and cerebellar white matter hypersignal intensity and significantly increased volume loss of white matter	ND	ND	43; C. J. Crosley, unpublished data (2004) and written communication to K. R. Kazacos (2004)
18/2005/M/7 yrs/Ontario	NR	MRI: patchy areas of abnormal enhancement of the cerebellar gray-white junction and small foci of nodular enhancement bilaterally in the cerebral cortex	MRI (3 mos): postinflammatory atrophy with ventricular enlargement, diffuse volume loss, and white matter gliosis	ND	ND	8, 44
19/2007/M/17 yrs/Oregon	NR	MRI: bilateral diffuse patchy T2 hyperintense lesions in periventricular and juxtacortical white matter, cerebellum, medulla, pons, and midbrain	NR	ND	ND	45
20/2007/F/18 mos/Missouri	NR	CT: scattered hypoattenuation in periventricular white matter; MRI: multifocal T2 hyperintense lesions throughout white matter	MRI (2 and 6 weeks): global atrophy and worsening hyperintense lesions throughout white matter	ND	ND	46; M. A. Jackson, unpublished data (2007) and written communication to K. R. Kazacos (2007)
21/2008/M/12 mos/New York	NR	MRI: acute demyelinating encephalomyelitis	MRI (8 days): increased demyelination progressing to severe atrophy	ND	ND	47
22/2008/M/14 mos/Massachusetts	NR	MRI: patchy T2 hyperintensity bilaterally in periventricular and deep cerebellar white matter; two areas of hyperintensity in cervical and thoracic spinal cord	NR	ND	ND	48, 49
23/2008/M/14 mos/Ontario	NR	MRI: diffuse, scattered subcortical, periventricular, and deep white matter lesions bilaterally	NR	ND	ND	50
24/2009/M/54 yrs/Missouri	Isoelectric (very low voltage)	MRI: cortical and central brain atrophy	MRI: scattered T2 hyperintense foci in corona radiata, subcortical white matter, and thalami	Biopsy: right frontal lobe showing marked nonspecific gliosis; autopsy: necrotizing eosinophilic meningoencephalitis with larvae	B. procyonis, 52-μm diam	51; M. Cohen, unpublished data (2009) and written communication to K. R. Kazacos (2011)
25/NR/F/73 yrs/British Columbia	NR	NR	NR	Autopsy: diffuse cerebral atrophy, probably unrelated; larvae in focal reactive and inflammatory nodules in deep white matter	B. procyonis, 65-μm diam	52

^aEEG, electroencephalogram; CNS, central nervous system; NR, not reported; ND, not done; CT, computed tomography; MRI, magnetic resonance imaging.

^byr, year of onset or presentation.