1/15. spinal cord schistosomiasis. A report of 2 cases and review emphasizing clinical aspects.Schistosomal myeloradiculopathy (SMR) is a severe and little known form of presentation of schistosomiasis mansoni and hematobic schistosomiasis. The literature concerning the entity is scarce, and most publications are limited to isolated case reports. Thus, to consolidate and analyze the knowledge currently available about the disease, I reviewed 231 cases, with emphasis on clinical aspects. Although variations occur, in most cases the clinical picture of SMR is highly suggestive in individuals with epidemiologic antecedents of the infection. Thus, a patient with SMR is usually a young male with no other manifestations of schistosomal infection who presents with lumbar pain, often of a radicular nature, soon followed by weakness and sensory loss of rapid progression in the lower limbs associated with autonomic dysfunction, particularly bladder dysfunction. The most suggestive elements of the entity, and therefore of higher diagnostic value, are the low localization of the spinal cord lesion, the acute or subacute onset of the disease, and the association of manifestations due to medullary and radicular involvement. SMR is commonly classified into clinical or anatomoclinical forms. However, I observed no consensus in this classification even in terms of the terminology used. The analysis performed in this review permitted the introduction of a new concept not yet reported in the literature regarding the possibility that the disease consists of a continuous spectrum, with asymptomatic egg laying in the spinal cord at 1 end of the spectrum and devastating forms at the other end, with most cases occupying an intermediate position and with the various types of damage overlapping and associated to different degrees. This concept applies not only to different patients but also to the same patient at different stages of the disease. Chemical and cytomorphologic examination of cerebrospinal fluid (CSF) almost always revealed mildly or moderately increased total protein concentration and predominantly lymphocytic pleocytosis. eosinophils, the least nonspecific finding, were detected in the CSF of less than half (40.8%) the patients. myelography and computed tomography-myelography were altered in 63.3% of cases, but this proportion may be an overestimate. The most frequent changes were images of a filling defect due to expansion of the spinal cord and were almost always demonstrated by the 2 imaging modalities. Although still few in number, early reports suggest that magnetic resonance imaging is more sensitive; however, the changes are also nonspecific, such as those revealed by myelography and computed tomography-myelography. Parasite eggs were demonstrated frequently in a biologic specimen (88.3%), but difficulty in detection was not uncommon. Peripheral blood eosinophilia was detected in 64.5% of patients and represented a nonspecific finding. The detection of anti-Schistosoma antibodies in the serum or CSF was also frequent (94.9% and 84.8%, respectively). The presence of anti-Schistosoma antibodies in serum is of limited value for the diagnosis of schistosomiasis in general, especially among individuals living in endemic areas; however, their quantification in the CSF has proved to be promising for diagnosis in the few studies conducted for this purpose. The large number of variables concerning treatment (such as drugs used and duration of disease at the beginning of treatment), together with the relative lack of information about the natural history of the disease, limit the analysis of aspects related to treatment and prognosis. Nevertheless, it was possible to conclude that corticosteroids and antischistosomotic drugs have a favorable effect on disease outcome and should be administered as early as possible. In addition to early treatment, factors linked to the disease itself affect prognosis. The new cases of SMR reported here are typical and illustrate the data discussed in this literature survey.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/15. Epidural Bilharzioma mansoni compressing the spinal cord: case report.A case of an epidural Bilharzioma mansoni (epidural granuloma due to Schistosoma mansoni) compressing the spinal cord at T11-T12 is presented. The patient, a 20-year old African man, started complaining of recurrent back pain since 1993 and became paraparetic in 1996. The myelography showed a complete block at T12 and the CT scan showed a mass at T11-T12 compressing the spinal cord. Through a bilateral laminectomy of T 10, T11 and T12, the bilharzioma was completely removed. The histopathology and the laboratory tests confirmed the diagnosis of granuloma due to schistosoma mansoni. The patient recovered completely and was seen last time more than one year after surgery. Not a similar case has been found in the literature and the authors presume that this is the first case ever successfully treated by surgery and chemotherapy and reported in the world literature.- - - - - - - - - - ranking = 1.5keywords = spinal (Clic here for more details about this article) |
3/15. Clinics in diagnostic imaging (52). spinal cord schistosomiasis.A 2-year-old Brazilian boy presented with bilateral leg weakness and constipation, followed by development of progressive paraparesis and bladder dysfunction. Neurological examination revealed flaccid paraparesis. blood tests and CSF analysis showed eosinophilia. The MR examination revealed a spinal cord mass extending from T9 to L1 levels, with a heterogeneously-enhancing solid component and a cystic component. Stool tests for schistosoma mansoni eggs were positive. The patient underwent surgery, the intramedullary mass was partially resected, and the diagnosis of spinal cord infection by schistosoma mansoni was confirmed. After surgery, the patient was treated with praziquantel and oxamniquine. He was discharged with partial improvement of the lower extremity weakness and bowel/bladder function. The clinical and imaging features of spinal cord schistosomiasis are reviewed.- - - - - - - - - - ranking = 0.75keywords = spinal (Clic here for more details about this article) |
4/15. spinal cord schistosomiasis in children: analysis of seven cases.We describe seven cases of children (ages 2 to 14 years) with myeloradiculopathy caused by infection with S. mansoni. None of them presented hepatosplenic involvement and one presented an intestinal picture. The myeloradicular and pseudotumoral forms were observed in four and three patients, respectively. Comparing the reports in the literature, we found that the pseudotumoral form is more similarly frequent among children than in adults, while the myelitic and myeloradicular forms are the most frequent and distributed across all age groups. diagnosis is based on clinical and epidemiological findings in association with laboratory tests. The diagnosis was confirmed by the presence of S. mansoni eggs in feces (5 cases) and / or the positivity in specific immunological tests (5 cases) associated with a cerebrospinal fluid inflammatory pattern with presence of eosinophils (between 1 and 24%). Magnetic resonance image, although it does not enable an etiological diagnosis, helped to confirm the form and spinal cord level of the lesion.- - - - - - - - - - ranking = 0.5keywords = spinal (Clic here for more details about this article) |
5/15. schistosoma mansoni myeloradiculopathy in an 8-year-old Omani boy.An 8-year-old Omani boy presented with progressive ascending weakness of the lower limbs with bowel and bladder incontinence. A diagnosis of myeloradiculopathy was made on neurologic examination. eosinophilia in the peripheral blood count and suspected endemicity in his region of residence raised the diagnostic possibility of neuroschistosomiasis. cerebrospinal fluid findings, high schistosoma antibody titre, magnetic resonance imaging of the spine, and detection of schistosoma mansoni eggs in the stool confirmed the diagnosis. The boy recovered significantly after receiving praziquantel and methylprednisolone. Neurological symptoms at presentation could be due to parasitic infection and should be considered in an endemic region. eosinophilia in the peripheral blood count may be the first indicator.- - - - - - - - - - ranking = 0.25keywords = spinal (Clic here for more details about this article) |
6/15. schistosoma mansoni of the conus medularis: case report.A six year old girl was admitted to the Kenyatta National Hospital paediatric unit with history of headaches, fever, neck stiffness and paraesthesias of the lower limbs. She was empirically commenced on antimeningitic treatment. Her neurological state deteriorated over a period of two months to paraparesis and paraplegia of the lower limbs with urinary and stool incontinence. A neurology review revealed a sensory level at T10 with power grade 2 in the lower limbs. A myelogram revealed a block of contrast at T12. An impression of cord compression by an intraspinal tumour was made. laminectomy and posterior midline myelotomy was performed. At operation a greyish-white intramedullary mass lesion was found. histology revealed a schistosoma mansoni ovum surrounded by granulomatous tissue with giant cells and polymorphoneuclear leucocytes. The child was commenced on paziquantel 1000 mg and dexamethasone 24 mg per day in divided doses. There was marked neurological improvement and the patient went home one month later. She was able to walk without support and was continent of urine and stool at the time of discharge.- - - - - - - - - - ranking = 0.25keywords = spinal (Clic here for more details about this article) |
7/15. Lumbar intramedullary spinal schistosomiasis presenting as progressive paraparesis: case report.OBJECTIVE AND IMPORTANCE: blood fluke infection or schistosomiasis affects up to 300 million people worldwide. Although infection of the hepatic and urogenital systems commonly occurs, central nervous system involvement is rare. When presenting in the spinal cord, schistosomiasis can be difficult to diagnose because it can present as mass lesion or transverse myelitis. We describe a patient with lumbar intramedullary spinal schistosomiasis who presented to a tertiary medical center in the united states and discuss the diagnosis and treatment of this rare disease. CLINICAL PRESENTATION: A 25-year-old Brazilian man presented with progressive, subacute, bilateral lower extremity motor and sensory deficits and disturbances in bladder function. magnetic resonance imaging revealed a diffusely enhancing mass expanding the region of the conus medullaris. INTERVENTION: Laboratory investigation disclosed serum and cerebrospinal fluid eosinophilia. Ultimately, cerebrospinal fluid serology demonstrated the presence of schistosoma mansoni. The patient was treated with praziquantel and steroids and made a marked recovery. CONCLUSION: The clinical and radiographic manifestations of spinal schistosomiasis can mimic those of intra-axial spinal tumors and transverse myelitis. To avoid unnecessary surgery or delay in treatment, the clinician must have knowledge of this type of presentation. The increasing volume of international travel and high prevalence of the disease worldwide increases the possibility that the practicing neurosurgeon in the united states may encounter this rare but treatable disease.- - - - - - - - - - ranking = 2.5keywords = spinal (Clic here for more details about this article) |
8/15. spinal cord schistosomiasis: a pediatric case mimicking intrinsic cord neoplasm.We present the clinical, myelographic, MRI, and histologic data on a 7-year-old girl with confirmed schistosoma mansoni infection of the spinal cord. MRI of the granulomatous spinal lesion revealed extensive enlargement of the cord in the T11-12 area, with some intramedullary swelling extending to T-5 through T-7. The clinical manifestations of spinal schistosomiasis can be diverse, and there should be a high index of suspicion for all patients from endemic areas.- - - - - - - - - - ranking = 0.75keywords = spinal (Clic here for more details about this article) |
9/15. Schistosomiasis of the spinal cord--underdiagnosed in south africa?Schistosomiasis is endemic in many areas of south africa, particularly the northern and eastern Transvaal. At Ga-Rankuwa Hospital in the northern Transvaal, 30 km north-west of Pretoria, spinal cord disease is common. In a substantial proportion of these cases no obvious cause for the condition can be found. In an attempt to draw attention to schistosomiasis as a possibly underdiagnosed cause of spinal cord disease, 3 cases of schistosomiasis of the spinal cord seen over a period of 3 years are reported. These 3 patients had histological evidence of spinal schistosomiasis. Because myelography of the spinal cord is often non-contributory in schistosomal involvement, it is suggested that patients with 'myelopathy of unknown origin' who come from an endemic area be given a therapeutic trial of praziquantel, especially if the serological findings are positive for schistosomiasis and the lower cord is involved.- - - - - - - - - - ranking = 2.25keywords = spinal (Clic here for more details about this article) |
10/15. Partial hypotrophy of the posterior and lateral columns of the spinal cord, representing a sequela of schistosomiasis mansoni: report of an autopsied case and a review of the literature.An autopsied case of schistosomiasis mansoni of the spinal cord is reported. The patient had been healthy until about five years before, when he presented with paraparesis, loss of sensibility from the pelvic girdle down and fecal and urinary incontinence which persisted until death. At autopsy there was old necrosis of most of the gray matter in the middle thoracic segment of the spinal cord and severe hypotrophy of the posterior columns in the lumbar spinal cord, of the posterior and anterior spinocerebellar tracts, and of the lateral corticospinal tract, unilaterally, in the entire thoracolumbar spinal cord from the middle thoracic segment on. In correspondence with these lesions, over one hundred schistosoma mansoni ova were found. No parasitism by S. mansoni in the brain and in the abdominal and thoracic viscera was found. This case is compared to others in the literature and a schistosomal etiology for spinal lesions is proposed. These lesions could represent a sequela of the prolonged destructive action of the granulomatous inflammatory process. The topography of the lesions, the relationship of schistosomiasis of the spinal cord to other anatomo-clinical forms of the disease, and how the spinal cord is reached by S. mansoni are commented upon.- - - - - - - - - - ranking = 3keywords = spinal (Clic here for more details about this article) |
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