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intense in ammatory reaction leading to hydrocephalus, vasculitis, and stroke as well as cranial nerve palsies This so-called racemose form of the illness is little altered by the use of praziquantel or any other form of therapy (Estanol et al) Treatment The therapy of this disorder has been greatly improved in recent years by the use of CT and MRI and the administration of praziquantel, an antihelminthic agent that is also active against all species of schistosomes The usual dose of praziquantel is 50 mg/kg of body weight, given orally daily for 15 to 30 days, depending upon the size and activity of the lesions Albendazole (5 mg/kg tid for 15 to 30 days), an alternative treatment, is believed by some to be more effective Initially, treatment may seem to exacerbate neurologic symptoms, with an increase in cells and protein in the CSF, but then the patient improves and may become asymptomatic, with a striking decrease in the size and number of cysts on CT scanning Corticosteroids may be useful if a large single lesion is causing symptoms by its mass effect Other Cestode Infections Infection with Echinococcus occasionally affects the brain The usual sources of infection are water and vegetables contaminated by canine feces After they are ingested, the ova hatch and the freed embryos migrate, primarily to lung and liver, but sometimes to brain (approximately 2 percent of cases), where a large solitary (hydatid) cyst may be formed The typical lesion is a large uid- lled cyst with the parasite visible by imaging procedures, but a solid nodular brain lesion, a chitinoma, is also known to occur We have also observed a compressive spinal cord lesion Treatment with the drug mebendazole is recommended when surgery is not feasible Cerebral coenuriasis (Coenurus cerebralis) is an uncommon infestation by larvae of the tapeworm Taenia multiceps It occurs mainly in sheep-raising areas where there are many dogs, the latter being the de nitive hosts The larvae form grape-like cysts, most often in the posterior fossa, which obstruct the spinal uid pathways and cause signs of increased intracranial pressure Surgical removal is possible Another cestode, Spirometra mansoni, may migrate within the.

FIGURE 2-16

Eosinophilic Meningoencephalitis Due to Parasites An eosinophilic meningoencephalitis, often with cranial nerve and painful polyradicular ndings, has been reported with Angiostrongylus cantonensis, Gnathostoma spinigerum, Paragonimus westermani, and Toxocara canis and cati infections In Angiostrongylus infections, snails, freshwater prawns, and unwashed lettuce carry the nematode The resulting illness may last for weeks to months, with pain, paresthesias, sensorimotor abnormalities, and a confusional state as the main manifestations Cook has reviewed these and other

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protozoan and helminthic infections of the CNS An interesting outbreak in a group of medical students who returned to the United States from Jamaica has been described by Slom and colleagues; they highlight paresthesias and dysesthesias but have noted the presence of eosinophilia in the blood or CSF in only half of their patients Hodgkin disease, other lymphomas, and cholesterol emboli will also occasionally incite an eosinophilic meningitis More detailed descriptions of parasitic diseases of the nervous system can be found in the monographs of Bia and of Gutierrez

FIGURE 9-11

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