Cerebral
sparganosis is clinically non-specific and easily misdiagnosed, exposing patients to the risk of severe brain damage and neurological dysfunction caused by actively migrating larvae. Diagnostic
biomarkers from typical cases can help to establish an early diagnosis and proper treatment. We present a 25-year-old woman who suffered from 9 years of
refractory epilepsy and was misdiagnosed with
glioma and subjected to surgery. The postoperative pathology confirmed
granuloma, and the
tumor-like foci reappeared 3 months later. Along with the "tunnel sign" on MRI, cerebral
sparganosis was suspected and confirmed by positive serum and cerebrospinal fluid
antibodies against Spirometra mansoni. The patient visited us after a failure of four cycles of
praziquantel treatment, recurrent
seizures and
hemiplegia with basal ganglia foci.
Craniotomy was not carried out until the larva moved to the superficial lobe on follow-up MRIs, and pathology revealed
sparganosis granuloma. The patient became seizure-free and recovered myodynamia but had long-lasting
cognitive dysfunction due to severe brain damage. This case indicated the importance of tunnel signs and moving
tumor-like foci on MRI as diagnostic clues of cerebral
sparganosis. An early diagnosis is vitally important to avoid severe neural dysfunction by the long-living and moving larvae. Surgical removal of the larva is a critical remedy for cases failed by
praziquantel treatment.