Cerebral Manifestations of Ascaris lumbricoides

Humans are the definitive host for the nematode, round-worm Ascaris lumbricoides, which generally produces only mild systemic symptoms. The authors report two cases of intestinal A. lumbricoides with concurrent cerebral manifestations. A 53-year-old Syrian woman with intestinal A. lumbricoides presented with a generalized seizure and a cerebral lesion that worsened for several days and then resolved after treatment with mebendazole. Magnetic resonance imaging revealed a 2-cm lesion in the right mesial temporal lobe. The lesion was hypointense to brain on T₁-weighted images and hyperintense on T₂-weighted images. There was a small focus of central enhancement. The second patient, a 2-year-old girl, died of a brain abscess with six organisms, including Neisseria mucosa, Eikenella corrodens, and microaerophillic streptococcus. The hypothesis that A. lumbricoides served as a vector for these bacterial pathogens, as well as potential alternative roles of A. lumbricoides in causing a polymicrobial bacterial abscess, are discussed. These cases suggest that specific treatment strategies including antihelminthic therapy or abscess resection may be successful in patients with cerebral lesions and concomitant intestinal A. lumbricoides.