Cerebral gnathostomiasis as a cause of an extended intracranial bleeding

This is a report of a fourteen year old Thai-girl who presented with acute hemiparesis because of intracranial haemorrhage six weeks after immigrating to Germany. Marked blood eosinophilia and raised IgE in serum in comparison with her origin led to the suspected diagnosis of parasitosis. Angiography showed mycotic aneurysm typical for cerebral gnathostomiasis one of the major causes of intracranial haemorrhage in children in Thailand. This diagnosis was confirmed by detecting specific antibodies against Gnathostoma spinigerum in serum and CSF by Western blot. Therapy was started with albendazole and dexamethasone and the girl made a complete recovery. In case of intracranial haemorrhage cerebral gnathostomiasis should be considered if the patient originates from an endemic area.