| 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. ( info) |
2/11. Cervical intramedullar schistosomiasis as a rare cause of acute tetraparesis. INTRODUCTION: The trematode infection schistosomiasis affects at least 200 million people in endemic areas. Granulomas cause the typical manifestations of urogenital, intestinal and hepatolienal schistosomiasis. Involvement of other organs especially the central nervous system (CNS) is uncommon. CASE REPORT: We describe a 40-year old male with a history of repeated contact with schistosome contaminated water. After having suffered from flu-like symptoms with fever and arthralgias, he first presented with a polyradiculopathy of unknown origin. Then 4 weeks later an acute tetraparesis occurred. Spinal magnetic resonance imaging (MRI) revealed a spinal stenosis and query medullary hyperintensities at C6-C8 without contrast-enhancement. Serologic testing was positive for schistosomiasis. The intraoperative appearance at decompressive laminectomy revealed a myelitic form of schistosomiasis. Under therapy with praziquantel, initially high dose cortisone and intensive physiotherapy, symptoms slowly improved over months. On follow-up 1 year later, the patient presented with a spastic distally marked tetraparesis and sensory impairment from C6 downwards. CONCLUSION: Cervical intramedullar schistosomiasis is a rare cause of acute tetra- or para-paresis in patients, who have had contact with schistosomes. early diagnosis is essential because of the excellent prognosis with specific therapy. ( info) |
3/11. Schistomiasis of the spinal cord: report two cases. Schistosomiasis affects over 200 million people worldwide. Schistosomiasis of the spinal cord is a rare occurrence. In Africa, there have been recent reports from egypt and south africa. In uganda, the last histological records were over two decades ago. Schistosomiasis of the spinal cord is commonly caused by schistosoma mansoni although schistosoma haematobium has been isolated. Two case reports are presented. In both patients, the diagnosis was made retrospectively. The first patient was a female patient with a lesion in the thoracic region. The second patient was a 21 year old male with a lesion in the conus. Apart from a block on the myelograms, all other laboratory investigations were negative. The diagnosis was made histologically in both cases with the identification of eggs of schistosoma in the spinal cord. The eggs could however, not be retrieved from the stool or urine samples. Both patients were treated with antischistosomal drugs and steroids. On follow up they had marked improvement in their neurological signs. We hope to renew attention in this rare but devastating neurological manifestation of a disease which affects many in our region and which if left untreated can lead to permanent neurological damage. ( info) |
4/11. Spinal schistosomiasis. A 23 year old female presented to Townsville General Hospital seven months after a positive urine test for Schistosomiasis with conus modularize signs. MRI confirmed a conus medullaris enhancing lesion. serology was positive for Schistosoma IgG : IgM, 3.4 : 1.8. urine screening for ova, stool sample, rectal biopsy and diagnostic investigations were negative. She was treated empirically for Schistosoma without biopsy with marked resolution of her symptoms and signs. She remains neurologically well one year after presentation. Serological identification from the Centre of disease Control and Prevention in Atlanta georgia by western blot has shown positive IgG for schistosoma haematobium and mansoni. Schistosoma myelopathy is a rare cause of transverse myelitis, conus medullaris syndrome, anterior spinal artery occlusion and radiculopathy in australia. It should however be included in the differential diagnosis in a patient who has been in or presenting from an endemic area. ( info) |
5/11. 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. ( info) |
6/11. Intramedullary schistosomiasis. A case study of intramedullary schistosomiasis in a 10-year-old child is reported. The patient presented with a short history of ascending paraparesis with no sensory loss. Sphincter dysfunction was rapid. She had surgical exploration and removal of a conus medullaris mass. Schistosomiasis was confirmed histologically. Combined steroid and praziquantel therapy improved her sphincter function and paraparesis. ( info) |
7/11. seizures and cerebral schistosomiasis. BACKGROUND: schistosoma mansoni is a parasitic trematoid worm that infects humans. Schistosomiasis is endemic in parts of south america, sub-Saharan Africa, the middle east, and some Caribbean islands. Disorders of the liver and gastrointestinal tract are the most common clinical manifestations. The central nervous system is not usually affected. The most common neurologic manifestation is transverse myelitis. In some circumstances, the eggs of S. mansoni are found in the brain, causing inflammatory reaction. OBJECTIVE: To describe a young Brazilian patient with partial epileptic seizures caused by a granulomatous lesion due to S. mansoni. CONCLUSION: In endemic areas or in patients with a positive epidemiological history, schistosomiasis must be considered as a possible diagnosis of seizures, particularly when they are associated with granulomatous lesions on magnetic resonance imaging. ( info) |
8/11. Schistosomal myelopathy mimicking spinal cord neoplasm. We describe a 48-y-old male with chronic progressive myelopathy suggesting thoracic intramedullary neoplasm but in whom laboratory workup disclosed schistosoma mansoni myelopathy. The case illustrates the need for careful investigation of schistosomiasis in patients from endemic regions with myeloradiculopathy signs. ( info) |
9/11. Paucisymptomatic brainstem lesions revealing CNS schistosomiasis. We describe clinical and magnetic resonance (MR) features in a 69-year-old, Caucasian woman presenting with an unusual meningeal onset of cerebral schistosomiasis. Magnetic resonance work-up demonstrated supra- and infratentorial lesions with prominent brainstem involvement contrasting with the paucisymptomatic clinical presentation. Because of a recent stay in uganda, including swimming in Lake victoria, a diagnosis of neuroschistosomiasis was suggested. Serological tests and rectal biopsy confirmed the putative diagnosis. The patient was successfully treated with praziquantel at a dose of 50 mg/kg/day for 15 days. brain MRI abnormalities improved dramatically within two months. ( info) |
10/11. An unusually late presentation of neuroschistosomiasis. Schistosomiasis is one of the most widespread parasitic infections in man. neuroschistosomiasis, referring to schistosomal involvement of the central nervous system, is an uncommon but well recognised complication of schistosomal infection. The duration between time of infection and onset of neurological symptoms typically varies between weeks to months. We describe a case of transverse myelitis secondary to neuroschistosomiasis, presenting more than three years after the time of initial schistosomal infection, diagnosed and treated in the district general hospital setting. ( info) |