Cerebral toxocariasis

Cerebral larva migrans (CLM) is an uncommon and rarely diagnosed entity.

Toxocariasis is a worldwide human helminthiasis, which is mostly asymptomatic and caused by toxocara canis, a roundworm in dogs. These can cause visceral larva migrans syndrome in humans who ingest contaminated soil. CNS manifestation with a focal mass lesion is very rare, seizures often being the first symptom.

Jagannath et al. reported a histopathologically proven case of CLM in a 13 year-old girl, who presented with bilateral focal seizures, right hemiparesis, and lapsed into altered sensorium prior to admission. Her CT scan was suggestive of a granulomatous lesion which eventually turned out to be CLM (toxocariasis). Interestingly, the lesion recurred after excision, with a confusing clinical picture. Following the second surgery, the pathology was reconfirmed and cure was provided for the disease. There has been no further intracranial recurrence during the past ten years although she developed cutaneous lesions 1)

A 11-year-old girl presenting with a generalized epileptic seizure and eosinophilia in blood. Under antibiotic therapy under the assumption of toxoplasmosis the lesion did not decrease and surgical resection was considered. We used computer-assisted surgery (CAS) for careful tissue resection. Postoperatively the diagnosis of toxocariasis was confirmed and albendozole medication was administered for 7 days. The patient developed well without neurological deficits or seizures.

They conclude that although neurological involvement is rare in toxocariasis, a cerebral infection in a child with epileptic seizures and eosinophilia should be considered 2)

A 1.5-year-old girl with a convulsion attack due to intracerebral granuloma in the right frontal lobe is reported. Her serum was positive with anti-human ascaris antibody, although no ova of the parasites were detected in the feces. She had grown up intimately with several cats in the home. These findings suggested that the granuloma was due to larva migrans of toxocara, which cross-reacts immunologically with human ascaris. Histological examination of the granuloma revealed no eosinophilic infiltration. No systemic reactions such as eosinophilia and hepatomegaly were found except for elevation of protein in cerebrospinal fluid. These were similar to those of ocular type of toxocara larva migran 3)

Jagannath PM, Venkataramana NK, Rao SA, Naik AL, Shivakumar SK, Saktepar A, Gopalakrishnan R, Shankar SK. Recurrent cerebral larva migrans: A case report and review of literature. J Pediatr Neurosci. 2009 Jan;4(1):36-40. doi: 10.4103/1817-1745.49107. PMID: 21887174; PMCID: PMC3162836.
B├Ąchli H, Minet JC, Gratzl O. Cerebral toxocariasis: a possible cause of epileptic seizure in children. Childs Nerv Syst. 2004 Jul;20(7):468-72. doi: 10.1007/s00381-004-0963-x. Epub 2004 May 12. PMID: 15138789.
Taira T, Beppu T, Matsumori K, Kubo O. [Intracerebral granuloma with serum anti-human ascaris antibody: case report]. No Shinkei Geka. 1987 Oct;15(10):1111-4. Japanese. PMID: 3431644.
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