Teaching NeuroImages: Magnetic Susceptibility-Weighted Imaging Mapped the Migratory Route of a Paragonimus in Brain

A 53-year-old man with a recent history of left temporal lobe hemorrhage presented with weakness of the left upper limb for 4 days. Paragonimus eggs were detected in the patient’s sputum (figure 1A). Workup revealed paragonimiasis, a lung flukeworm infection endemic to East Africa, West Africa, and South America, which rarely involves brain.1 Characteristic tunnel sign was visualized on brain MRI (figure 1B). Notably, susceptibility-weighted imaging revealed a migratory pattern of the parasite from the left temporal lobe to the right parietal lobe and resultant patchy hemorrhage (figure 2). Treatment with praziquantel resulted in favorable outcome without residual deficits.

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