Chinese Medical Journal

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RECENT ADVANCES IN DIAGNOSIS OF PARAGONIMIASIS 5

to light was weak. Babinski’s sign of both sides were normal. Kernig’s sign of the right side was positive. Reflex of upper and lower limbs of both sides decreased. Pressure of cerebrospinal fluid was 290 mm. Leukocytes 4. Pandy’s test 4 plus. Cardiac rate 140 per minute and rhythm weak. Emergency treatment was given without effect. The patient finally died on February 1, 1955.

PATHOLOGICAL EXAMINATION. Chest cavity. There were extensive fibrous adhesions between the lungs, chest wall, diaphragm, and pericardium as well as between the lobes of the lungs themselves.

Lungs. On the surface of the posterolateral aspect of the right lower lobe about 2 em from the lower costal margin there was a horizontal band of fibrous thickening, moderately firm, measuring about 6 by 0.8 cm. On section it was found to contain a dry yellowish granular substance which microscopically was composed of necrotic tissue surrounded by fibrous tissue with infiltration of lymphocytes and a small number of leukocytes and foreign body giant cells. However, neither paragonimus ova nor parasites were observed. In the medial aspect of the left lower lobe four scattered lesions similar to the above were seen, the largest being 1 by 0.7 cm.

Brain. The two frontal lobes were not symmetrical, the right being larger, softer, with flattened conyolutions and shallow sulci. The brain tissue of the left frontal lobe near the anterior third of the central sulcus was slightly depressed, dull and yellowish-red. Near the inferior sulcus there was a small amount of fibrinous exudate.

The left temporal lobe was soft and larger than the right, its sulci were shallow.

Sections of the brain revealed the following:

a. Scattered necrotic lesions near the lateral side of the left frontal lobe (the largest measuring 0.4 by 0.3 em) pale-yellow, and surrounded by dense fibrous tissue.

b. Scattered irregular intercommunicating necrotic lesions were seen at the posterior one third of the superior frontal suleus of the right frontal lobe. These lesions had greyish-yellow coagulated material in the center. The largest measured 1 cm in diameter. The left ventrical was dilated.

c. The necrotic lesions in the right temporal lobe were even more extensive, occupying one third of the area in the coronal sections of the hemisphere. The lateral ventricle was compressed and reduced in size.

d. In the central part of the right temporal lobe the necrotic lesions were extensive. The basal ganglia, globus pallidus and claustrum were largely destroyed. The necrotic parts were close to the margin of the anterior branch of the internal capsule, the largest area of necrosis measuring 2 cm in diameter.

e. The lateral ventricles of the occipital lobes were all dilated, including the fifth ventricle.

Microscopic examination. The central portion of the necrotic area was stained red and was surrounded by several layers with different types of cells. The innermost layer contained small numbers of broken nuclei, the next layer contained granulation tissue, further out was a layer of dense tissue composed of fibrocytes and glia cells, and the outermost layer was infiltrated by many inflammatory cells composed of neutrophils, eosinophils, plasma cells, lymphocytes and phagocytes. In this region could be seen various numbers of ova, some of which were already surrounded or invaded by foreign body giant cells.

The right parietal lobe contained organized lesions in addition to necrotic foci, also containing ova. The meninges of the right parietal lobe were intimately adherent to the necrotic foci and they showed lymphocytic infiltration and ova.

The wall of the lateral ventricle in the left occipital lobe was also damaged. A few ova were seen in the ventricular cavity. The brain tissue surrounding the necrotic areas showed evidence of degeneration.