Sir,
The subarachnoid hemorrhage is an important neurological problem which is usually due to
the problem of vascular structure. However, there are also other uncommon causes.
Gnathostomiasis is a tropical parasitic infection that is common in Southeast Asia. This
disease usually causes migratory swelling with eosinophilia. Internal organ involvement
is also possible. Focusing on neurognathostomiasis, it is a rare presentation. The
subarachnoid hemorrhage can also be due to the neurognathostomiasis. In this short
article, the authors report a summary on previous publications on Thai patients with
subarachnoid hemorrhage due to neurognathostomiasis. According to the literature search
(PubMed and ThaiIndexMedicus), there are at least 20 Thai cases with reported
subarachnoid hemorrhage due to neurognathostomiasis (due to the incomplete data in the
primary records, the demographic data of the patients cannot be summarized)11 Munkong W, Sawanyawisuth K, Pongtipakorn K, Kongbunkiat K,
Limpawattana P, Senthong V e ta alSubarachnoid hemorrhage due to vascular causes
and gnathostomiasis: clinical features and laboratory findings. Southeast Asian
J Trop Med Public Health. 2014;45(5):984-9.,22 Intapan PM, Khotsri P, Kanpittaya J, Chotmongkol V, Sawanyawisuth K,
Maleewong W. Immunoblot diagnostic test for neurognathostomiasis. Am J Trop Med
Hyg. 2010;83(4):927-9.
http://dx.doi.org/10.4269/ajtmh.2010.10-0113
https://doi.org/10.4269/ajtmh.2010.10-01...
,33 Visudhiphan P, Chiemchanya S, Somburanasin R, Dheandhanoo D. Causes
of spontaneous subarachnoid hemorrhage in Thai infants and children: a study of
56 patients. J Neurosurg. 1980;53(2):185-7.. Of these cases, all have the classical signs and symptoms of
subarachnoid hemorrhage and brain imaging by CT or MRI confirm for hemorrhagic problem.
Of interest, there is no case that imaging can identify the parasite. All cases were
serological and immunological diagnosed for neurognathosomiasis (in both sera and CSF).
In all case, esosinophilia and high CSF eosinophil count can be seen. Focusing on the
outcome of diseases, there is no report on fatality. Finding of high CRF eosinophil
count in adding to red blood cell due to hemorrhage is usually the first clue for
further diagnosis of neurognathostomiasis. This seems that the subarachnoid hemorrhage
due to gnathostomiasis has a better prognosis than subarachnoid hemorrhage due to
vascular accident. Medical treatment by antiparasitic drug has no role but the basic
surgical management of subarachnoid hemorrhage can be effective. It is also recommended
that neurognathostomiasis should be included as an important differential diagnosis for
subarachnoid hemorrhage, especially for the patients living or having history of
traveling to tropical endemic areas.
References
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1Munkong W, Sawanyawisuth K, Pongtipakorn K, Kongbunkiat K, Limpawattana P, Senthong V e ta alSubarachnoid hemorrhage due to vascular causes and gnathostomiasis: clinical features and laboratory findings. Southeast Asian J Trop Med Public Health. 2014;45(5):984-9.
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2Intapan PM, Khotsri P, Kanpittaya J, Chotmongkol V, Sawanyawisuth K, Maleewong W. Immunoblot diagnostic test for neurognathostomiasis. Am J Trop Med Hyg. 2010;83(4):927-9. http://dx.doi.org/10.4269/ajtmh.2010.10-0113
» https://doi.org/10.4269/ajtmh.2010.10-0113 -
3Visudhiphan P, Chiemchanya S, Somburanasin R, Dheandhanoo D. Causes of spontaneous subarachnoid hemorrhage in Thai infants and children: a study of 56 patients. J Neurosurg. 1980;53(2):185-7.
Publication Dates
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Publication in this collection
Mar 2015
History
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Received
26 Nov 2014 -
Reviewed
19 Nov 2014 -
Accepted
10 Dec 2014