A 21-year-old Indonesian woman came to hospital with severe headache and vomiting. Brain MRI showed multiple subcortical lesions. High-intensity transient signals (HITS) was detected in the carotid artery and transesophageal echocardiography (TEE) was performed to search for embolic sources. Mobile string-like structures were found in the aortic arch. We started anticoagulation therapy. One month later, TEE reexamination revealed that the aortic arch cord had shrunk, but numerous cords were found in the pulmonary artery. She was suspected with
Angiostrongylus cantonensis infection and treated with antiparasitic agent and steroids. One month later, the TEE was performed again, and the cord-like structure in the aortic arch almost disappeared, and the abnormal structure in the pulmonary artery also disappeared. It is known that
A. cantonensis can cause eosinophilic meningoencephalitis, but its prognosis is good, and it is thought that it may be mild. In this case, although the definitive diagnosis has not been made, the possibility was considered to be high because antiparasitic agent was effective. HITS detection for investigating the cause of multiple subcortical lesions was considered to be useful in determining the embolic mechanism.
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