CNS-disseminated Angiostrongylus cantonensis mimicking atypical demyelinating disease

A healthy 44-year-old woman developed malaise and severe headache shortly after returning from vacation in Hawaii. As initial symptoms cleared after 24 hours, over the subsequent days, she developed paresthesias in her lower extremities (knees to feet), new-onset urinary retention, and midthoracic radicular pain. Brain MRI revealed nonenhancing lesions in the medulla and midbrain, in addition to punctate subcortical frontal lesions (figure). MRI of the cervical spine revealed 2 nonenhancing lesions at C3-C4 and C6-C7 (figure). She was diagnosed with MS and contemplated disease-modifying therapy (DMT).