CT-evidence of subarachnoid hemorrhage due to presumed gnathostomiasis.

SPONTANEOUS SUBARACHNOID HEMORRHAGE is due to aneurysmal rupture in most cases and is easily detected with computerized tomography (CT). Nevertheless, approximately 20 percent of cases of subarachnoid hemorrhage documented with lumbar puncture have no explainable cause on subsequent diagnostic evaluation. Parasitic infestation with Gnathostoma spinigerum is a surprisingly frequent cause of subarachnoid hemorrhage in the pediatric and adolescent populations of Indochina.' 2 The presence of a meningomyeloencephalitis with cerebrospinal fluid (CSF) eosinophilia is a strong clue to the cause in such cases. A ngiostrongylus cantonensis, another nematode found in the Far East, can produce similar features but has a lesser predilection for the spinal cord and generally causes a less severe infection.3 In view of the recent influx of Indochinese immigrants to this country, it is important for clinicians to bo aware of these entities. We report a case of a patient in whom meningomyeloencephalitis with CSF eosinophilia developed and who suffered a subarachnoid hemorrhage on his arrival in the United States.