Brain bow worm disease is a parasitic infection caused by the Toxoplasma gondii, usually lurking in the human body without detection. However, for individuals with impaired immune systems, especially those infected with the HIV virus (HIV), bowworm infections can lead to serious complications, of which cerebral bowel disease is particularly dangerous. Clinical manifestations of the disease are complex and variable, and can easily be confused with other nervous system diseases, posing great challenges to diagnosis. This paper will provide an in-depth analysis of a particular case of cerebral albinosis, the initial symptoms of which are akin to acute ischaemic stroke, placing obstacles in our diagnosis and treatment, and highlighting the importance of maintaining a high level of vigilance in the treatment of neuro-system diseases and of a comprehensive diagnosis.
The patient is a 65-year-old woman, who is admitted after 10 days due to sudden infirmity, numbness and walking difficulties on the right side. It is worth noting that these symptoms suddenly appeared, but no further increase or fluctuations occurred thereafter. Patients deny the symptoms associated with headaches, fever, dizziness, cognitive disorders, difficulty swallowing, water coughing and incontinence. In addition, the patient had no risk factors for cerebrovascular diseases and denied a history of smoking, drinking alcohol or other infectious diseases. These seemingly common symptoms and the lack of a specific history of the disease make it easy for doctors to give preliminary consideration to common cerebrovascular diseases such as acute ischaemic stroke.
The post-hospital medical examination showed that the patient had a clear consciousness, complete orientation, a temperature of 36°C, blood pressure of 112/74 mmHg, and no abnormal neuropsy. However, there is a marked decrease in the sense and muscle of the right limb, which is rated at level I only, while the muscle of the left limb is rated at level IV, with significant differences. The lower right leg of Babinski is positive, suggesting that there is a potential for cone beam damage. The National Health Research Institute’s mid-term assessment score of 8 points appears to support the initial diagnosis of “acute ischaemic stroke”. However, instead of stopping there, we have arranged for further MRI scans and laboratory examinations to try to identify the real causes of the disease.
On the third day of hospitalization, the patient ‘ s serology test was positive. This discovery serves as a wake-up call to remind us of the need to reassess the patient ‘ s condition and to actively seek evidence of opportunistic infections. Combined with the results of the video-testing and the sequence (mNGS) of the condensed macrogene of the brain, it was determined that the patient did not suffer from a stroke, but rather from the HIV-related cerebral bowworm disease.
The specificity and complexity of this case are manifested in many ways. First, the patient’s clinical performance is very unusual. Typical symptoms of cerebral bowworm disease include headaches, fever, lack of neurological function, epilepsy, change of consciousness, etc. However, the patient is shown to be only one-sided symptoms of an acute ischaemic stroke and lack of typical symptoms of cerebral bowel disease, which undoubtedly makes early diagnosis more difficult. Secondly, the HIV infection status of patients is a key factor in the occurrence of cerebral bowworm disease. HIV infection can seriously damage the immune system, providing an opportunity for latent bowworms to re-activate and trigger brain infections. Therefore, HIV testing is essential for unidentified brain disorders, especially those with low immunity.
Visual examinations played a key role in the diagnosis of the case. MRI displays mixed signals of multiple plastering in the left side of the base section, the semi-egg centre, the side brain, the dome and the meso-brain area, DWI displays multi-micro-microlayered restricted areas, enhances MRI displaying nostrils or eccentric reinforcements, embedding weighted imaging shows a decrease in brain blood flow in the region of the stove, MRI spectra shows the disappearance of N-acetyl-day tortamine peaks and a rise in lipid peaks. These visual characteristics are consistent with those of cerebral bowel disease, which helps doctors to identify and diagnose other brain diseases. In addition, the MNGS test of the cerebral vertebrate is the gold standard for the diagnosis of brain bow worm disease. This technology enables rapid and accurate detection of the DNA of the bowworm in the fluid of the brain, providing a reliable basis for clinical diagnosis.
The case suggests that, even in the time-window of an intravenous embolism or vascular treatment, a full-scale video and laboratory examination is required to remove other potential diseases and avoid misdiagnosis. For people infected with HIV or other people with low immunity, the possibility of opportunistic infections, such as cerebral bowel disease, should be given greater vigilance. In the diagnostic process, advanced diagnostic techniques, such as MRI, brain vertebral fluid examination and mNGS, are essential to enable doctors to make early and more accurate diagnostics. Early diagnosis and timely treatment are key to improving the prognosis and reducing complications.
Finally, the case re-emphasizes the importance of health education. The public needs to be informed about the route of transmission of bowel worm disease and preventive measures, such as avoiding the consumption of uncooked meat and the exposure to cat dung. In the case of HIV-infected persons, preventive measures should be strengthened to avoid opportunistic infections. In general, cerebral bowworm disease is a complex disease with diverse clinical performance and prone to misdiagnosis. The case highlights the challenge of disease diagnosis with its atypical symptoms similar to stroke. Through detailed medical history collection, comprehensive medical examination and advanced visual and laboratory examinations, it is possible to increase the rate of diagnosis of cerebral bowel disease and to guide clinical doctors in the development of individualized treatment programmes, with the ultimate aim of improving the patient ‘ s prognosis and reducing the risk of disease.
