Neuroimaging findings in a woman with brainstem paragonimiasis: a case report and review of the literature

INTRODUCTION: The most serious erratic migration of paragonimiasis is a cerebral paragonimiasis. Infection in the temporal and occipital lobes of the brain has been previously reported in cerebral paragonimiasis. Here, we report a case of chronic brainstem paragonimiasis. CASE PRESENTATION: A 29-year-old Chinese woman presented to our hospital complaining of a sudden onset, three days previously, of double vision and dizziness. A computed tomography scan and diffusion-weighted images looked like an ischemic stroke. However, conglomerates of multiple ring-like enhancements on contrast magnetic resonance imaging, and the characteristic appearance of the ‘tunnel sign’, were found on further examination. Our patient was treated with praziquantel to prevent the spread of the paragonimiasis. She was followed up three months later and showed good recovery. CONCLUSIONS: Conglomerates of multiple ring-like enhancements on contrast magnetic resonance imaging and the characteristic appearance of the ‘tunnel sign’ were important for the diagnosis of chronic brainstem paragonimiasis.