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Published on: August 11, 2015
Intracranial Pseudoaneurysm Caused by Cerebral Paragonimiasis in Pediatric Patients
Lusheng Li1, Yuting Zhang2, Jin Zhu3
1Department of Neurosurgery; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Chongqing Key Laboratory of Pediatrics; Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.
Insights
Intracranial pseudoaneurysms are common in pediatric cerebral paragonimiasis with hemorrhage. Rupture of these pseudoaneurysms is a frequent characteristic of this condition in children.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Cerebral paragonimiasis can lead to intracranial hemorrhage in pediatric patients.
- The occurrence of intracranial pseudoaneurysms in this context is not well-established.
Purpose of the Study:
- To determine the proportion of pediatric patients with cerebral paragonimiasis and intracranial hemorrhage who develop intracranial pseudoaneurysms.
Main Methods:
- Retrospective analysis of 17 pediatric patients with cerebral paragonimiasis and secondary intracranial hemorrhage.
- Evaluation of computed tomographic angiography (CTA) images for the presence of intracranial pseudoaneurysms.
- Confirmation of cerebral paragonimiasis via antibody testing and histopathology.
Main Results:
- Intracranial pseudoaneurysms were identified in 35.3% (6/17) of pediatric patients.
- Pseudoaneurysms showed varying degrees of surrounding hemorrhage at initial presentation.
- Follow-up CTA revealed resolution in two patients, persistence requiring surgery in two, and ongoing monitoring in the remaining two.
Conclusions:
- Ruptured intracranial pseudoaneurysms are a common feature of secondary intracranial hemorrhage in pediatric cerebral paragonimiasis.
- Pseudoaneurysm formation should be considered in the diagnostic workup of pediatric patients with cerebral paragonimiasis and hemorrhage.
Background:
We investigated the proportion of pediatric patients with cerebral paragonimiasis and intracranial hemorrhage who have intracranial pseudoaneurysms.
Methods:
Images of 17 pediatric patients with cerebral paragonimiasis that first manifested as secondary intracranial hemorrhage were evaluated. All patients underwent computed tomographic angiography before surgery. A diagnosis of cerebral paragonimiasis was confirmed based on a positive Paragonimus-specific antibody test in serum samples from all 17 patients. Cerebral paragonimiasis in five of the 17 patients was further confirmed by histopathological examination of surgical specimens.
Results:
Computed tomographic angiographic images for six of the 17 patients (35.3%) showed the presence of intracranial pseudoaneurysms. Follow-up computed tomographic angiographic scans two years later showed that two of the six patients had persistent pseudoaneurysms and underwent aneurysmectomy. The diagnosis of pseudoaneurysm was confirmed by histopathological examination postsurgery. In another two of the six patients, the pseudoaneurysm lesions were absorbed and could no longer be seen on three- to six-month follow-up scans. The final two patients with pseudoaneurysms are still under follow-up. Intracranial pseudoaneurysms with various degrees of surrounding hemorrhage were frequently observed at first manifestation.
Conclusions:
The rupture of intracranial pseudoaneurysms is a common characteristic feature of secondary intracranial hemorrhage caused by cerebral paragonimiasis in pediatric patients.
