Disseminated and migratory sparganosis in the central nervous system: A case report and literature review of combined spinal and intracranial involvement.

Background: Central nervous system (CNS) sparganosis is an exceptionally rare parasitic infection caused by the larvae of Spirometra species. Its migratory nature and nonspecific clinical presentation often lead to misdiagnosis, posing significant diagnostic and therapeutic challenges. While CNS involvement typically affects either the brain or spinal cord, disseminated cases involving both regions are exceedingly rare.

Case description: We report the case of a 34-year-old woman who initially presented with progressive low back pain and paraparesis. She was diagnosed with spinal sparganosis following surgical resection and histopathological confirmation. Despite an uneventful postoperative recovery, she developed progressive headaches 3 years later. Magnetic resonance imaging revealed intracranial lesions, and subsequent surgery confirmed sparganosis in the cisterna magna. One year after brain surgery and ventriculoperitoneal shunt placement, the patient experienced progressive headaches accompanied by confusion. Under the initial misdiagnosis of brain abscess, she was inadvertently treated with intravenous metronidazole for 2 months, resulting in symptomatic improvement. However, a review of imaging demonstrated extensive CNS involvement, including the supratentorial, infratentorial, and upper cervical regions. In addition, there was clear evidence of parasite migration through the cribriform plate into the frontal lobe, highlighting the disseminated and migratory nature of CNS sparganosis.

Conclusion: This case highlights the diagnostic complexity and disseminated nature of CNS sparganosis, underscoring the importance of early surgical intervention and histopathological confirmation. The unexpected clinical response to metronidazole raises the possibility of its adjunctive role in symptom modulation, although its antiparasitic efficacy remains unproven. Given the risk of asymptomatic dissemination and recurrence, long-term follow-up with serial imaging is essential. Clinicians should maintain a high index of suspicion for sparganosis in endemic regions to improve diagnostic accuracy and patient outcomes.