Intracranial pseudoaneurysm caused by cerebral paragonimiasis in pediatric patients

Abstract Objective The present study aims to investigate the proportion of pediatric patients with cerebral paragonimiasis (cerebral PGM) and intracranial hemorrhage (ICH) who have intracranial pseudoaneurysms. Methods Images of 17 pediatric patients with cerebral PGM that first manifested as secondary ICH were evaluated retrospectively. All patients underwent computed tomography angiography (CTA) scans before surgery. A diagnosis of cerebral PGM was confirmed based on a positive Paragonimus-specific antibody test in serum samples from all 17 patients. Cerebral PGM in 5 of the 17 patients was further confirmed by histopathological examination of surgical specimens. Results CTA images for 6 of the 17 patients (35.3%) showed the presence of intracranial pseudoaneurysms. Follow-up CTA scans 2 years later showed that two of the six patients had persistent pseudoaneurysms, and underwent aneurysmectomy. The diagnosis of pseudoaneurysm was confirmed by histopathological examination post-surgery. In another two of the six patients, the pseudoaneurysms lesions were absorbed and could no longer seen on 3 to 6-month follow-up scans. The final two patients with pseudoaneurysms are still under follow-up. Intracranial pseudoaneurysms with various degrees of surrounding hemorrhage were frequently observed at first manifestation. Conclusions The rupture of intracranial pseudoaneurysms is a common characteristic feature of secondary ICH caused by cerebral PGM in pediatric patients.