Treatment This consists of praziquantel orally in a dosage of 20 mg/kg tid. In one series, 8 of 9 patients with epilepsy caused by cerebral schistosomiasis became seizure free after treatment with praziquantel. Surgical excision of spinal granulomatous tumors is sometimes indicated, but the results are unpredictable. Corticosteroids are often given concurrently.
An eosinophilic meningoencephalitis, often with cranial nerve and painful polyradicular findings, has been reported with Angiostrongylus cantonensis, Gnathostoma, Paragonimus, and Toxocara canis and cati infections. In Angiostrongylus infections, snails, freshwater prawns, and unwashed lettuce carry the nematode. The resulting illness may last for weeks to months, with pain, paresthesias, sensorimotor abnormalities, and a confusional state as the main manifestations. Cook has reviewed these and other protozoan and helminthic infections of the CNS. An interesting outbreak in a group of medical students who returned to the United States from Jamaica was described by Slom and colleagues; they highlighted paresthesias and dysesthesias but noted eosinophilia in the blood or CSF in only half of their patients. Meningeal Hodgkin disease, other lymphomas, and cholesterol emboli also occasionally incite eosinophilic meningitis.
More detailed descriptions of parasitic diseases of the nervous system can be found in the monographs of Bia and of Gutierrez.
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