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Ibrahim M, Gad K, Khan T, Yousef W, Shabbir Z, Najibullah M, Abodief WT, Jarkhi HH, Azab WA. Pseudotumoral Encephalic Schistosomiasis: A Literature Review. World Neurosurg 2024; 184:5-13. [PMID: 38159601 DOI: 10.1016/j.wneu.2023.12.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/24/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
Pseudotumoral encephalic schistosomiasis (PES) is the chronic form of cerebral neuroschistosomiasis, and is rarely encountered in clinical practice. Clinically, PES closely resembles other intracranial space-occupying lesions including brain tumors. Laboratory investigations are usually inconclusive, and neuroradiologic findings are frequently reported as non-specific. Such diagnostic difficulties may result in delayed diagnosis and treatment. Across the literature, there is a paucity of information about and controversy over many aspects of the disease. Particularly, inconsistent magnetic resonance imaging (MRI) findings, a wide variation of medical treatment protocols, lacking consensus regarding the indications of surgery, and undetermined information regarding the impact of the extent of resection on prognosis. We herein review the pertinent literature with the aim of providing focused information regarding the pathogenesis of PES, its currently identified more distinctive neuroimaging features, and the indications and extent of surgery in light of the state-of-the-art operative neurosurgical practice. A distinctive multinodular arborizing pattern of PES lesions can often be observed on MRI in patients with PES. Praziquantel is considered by many authors to be the drug of choice in all cases, and seems to be effective at variable dose regimens. Although lesion excision utilizing current technology is generally safe, the indications and extent of surgery are still undetermined and should be decided on a case-by-case basis. Multicenter collaborative research is further needed to fill the existing gaps in the current knowledge on PES.
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Affiliation(s)
- Marwa Ibrahim
- Tropical Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt; Infection Control Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Khaled Gad
- Medical Imaging Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Tufail Khan
- Neurosurgery Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Waleed Yousef
- Neurosurgery Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Zafdam Shabbir
- Neurosurgery Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Mustafa Najibullah
- Neurosurgery Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Wael T Abodief
- Histopathology Department, Al-Sabah Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Hussain H Jarkhi
- Histopathology Department, Al-Sabah Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Waleed A Azab
- Neurosurgery Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait.
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Pambe CJRN, Ngaroua D, Amvene JM, Kabeyene AC, Nkodo JMM. [Histopathology of a rare case of intramedullary schistosomiasis and literature review]. Pan Afr Med J 2020; 37:153. [PMID: 33425186 PMCID: PMC7757216 DOI: 10.11604/pamj.2020.37.153.24890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/26/2020] [Indexed: 11/15/2022] Open
Abstract
Schistosomiasis is a major public health problem in sub-Saharan Africa and, in particular, in Cameroon. It is the second parasitic disease endemic after malaria and it is favoured by the coexistence of bioclimatic zones. We report the case of a 6-years old girl presenting with clinical deficit syndrome and medullary infiltration mimicking tumor on medical imaging. Surgery helped to clarify the diagnosis after histopathological examination of the biopsic specimens. The patient had also received a dose of Praziquantel. Regression of symptoms as well as favorable progression of the operative wound facilitated discharge from hospital. The patient was lost to follow-up for three years. Effective management of neuromeningeal bilharziosis should be multidisciplinary.
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Affiliation(s)
| | - David Ngaroua
- Faculté de Médecine et des Sciences Biomédicales de Garoua, Université de Ngaoundéré, Ngaoundéré, Cameroun
| | - Jérôme Mbo Amvene
- Faculté de Médecine et des Sciences Biomédicales de Garoua, Université de Ngaoundéré, Ngaoundéré, Cameroun
| | - Angèle Clarisse Kabeyene
- Faculté de Médecine et des Sciences Biomédicales de l´Université de Yaoundé I, Yaoundé, Cameroun
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Manamal NA, Singhal T, Kumar A, Sanghvi D, Mani J. Neuroschistosomiasis: An Unusual Intracranial Space Occupying Lesion. Indian Pediatr 2018; 55:993-994. [PMID: 30587650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Neuroschistosomiasis is an uncommonly reported disease. CASE CHARACTERISTICS An adolescent Indian boy residing in Kenya presented with headache, visual symptoms and seizures, with MRI showing space-occupying lesions in the occipital lobe and cerebellum. OBSERVATION Brain biopsy was diagnostic of neuro-schistosomiasis; complete recovery was seen with praziquantel and corticosteroid therapy. MESSAGE This case highlights the importance of considering epidemiology in differential diagnosis and establishing definitive diagnosis even if it is by invasive methods.
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Affiliation(s)
- Nevitha Athikari Manamal
- Department of Laboratory Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Tanu Singhal
- Department of Pediatrics, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India. Correspondence to: Dr Tanu Singhal, Department of Paediatrics, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai 400 053, India.
| | - Abhaya Kumar
- Department of Neurosurgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Darshana Sanghvi
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Jayanti Mani
- Department of Neurology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
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Machiels JD, Cobussen M, Bosboom RW, van Os NJH, Hageman ATM, Hassing R. [Myelitis transversa caused by neuroschistosomiasis]. Ned Tijdschr Geneeskd 2018; 162:D2382. [PMID: 30040277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Neuroschistosomiasis is a severe complication of an infection with Schistosoma; this infection can lead to myelitis transversa. Acute myelitis transversa is a rare disorder of the spinal cord, which can present with muscular weakness, sensory disturbance and intestinal or bladder dysfunction. CASE DESCRIPTION A 17-year-old refugee from Eritrea, who had been in the Netherlands for 3 weeks, suffered from back pain and progressive weakness of both legs for one week. Both the clinical presentation and the MRI images were consistent with myelitis transversa. Schistosomamansoni eggs were found in the faeces, and antibodies to Schistosoma eggs and worms were found in both liquor and serum, leading to a diagnosis of neuroschistosomiasis. The patient recovered completely following treatment with praziquantel and prednisone. CONCLUSION Schistosomiasis is a commonly occurring parasitic disease in sub-Saharan Africa, which can lead to myelitis transversa if it spreads to the spinal cord. Early detection and treatment are necessary to prevent lasting damage. A good geographical case history is essential for this process.
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Affiliation(s)
- Julian D Machiels
- Rijnstate, afd. Medische Microbiologie, Arnhem
- Contact: J.D. Machiels
| | | | | | | | | | - R Hassing
- Rijnstate, afd. Interne Geneeskunde, Arnhem
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Tan E, Marcelin JR, Virk A. 44-Year-Old Man With Left-Sided Paresthesias and Homonymous Hemianopsia. Mayo Clin Proc 2015; 90:1278-82. [PMID: 26355402 DOI: 10.1016/j.mayocp.2015.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 01/26/2015] [Accepted: 02/02/2015] [Indexed: 11/20/2022]
Affiliation(s)
- Eugene Tan
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | | | - Abinash Virk
- Advisor to resident and fellow and Consultant in Infectious Diseases, Mayo Clinic, Rochester, MN
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Zhu F, Huang X, Wu M, Jin WX, Xie K. [Diagnosis and treatment of cerebral schistosomiasis: a report of 166 cases]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2014; 26:695-696. [PMID: 25856906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To discuss the clinical features, diagnosis and treatment of cerebral schistosomiasis. METHODS A total of 166 patients with cerebral schistosomiasis were treated, and their clinical data were collected and analyzed retrospectively. RESULTS In 166 cases of cerebral schistosomiasis, the confirmative diagnoses of 156 cases were diagnosed according to the clinical manifestation, etiology, immunology and auxiliary examination (CT, MRI). In among, 74 cases were confirmed by pathological examination, 10 cases were diagnosed through to the diagnostic treatment. Totally 102 patients received the oral medication of praziquantel, and they all improved and discharged 14-16 days later; 64 patients received the craniotomy and praziquantel medication after the operation, and 48 patients significantly improved, others did not improve or aggravated. There was no operative mortality. CONCLUSIONS Neuroimaging and laboratory tests are valuable in the diagnosis of cerebral schistosomiasis. The praziquantel treatment is selected firstly when the diagnosis was established. However, in the case of serious intracranial hypertension, intractable epilepsy and praziquantel treatment fails, the surgical treatment is required.
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Carod-Artal FJ. [Tropical causes of epilepsy]. Rev Neurol 2009; 49:475-482. [PMID: 19859889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Eighty-five percent of all epileptics live in tropical regions. Prenatal risk factors, traumatic brain injuries and different parasitic infestations of the central nervous system (CNS) are the reasons behind the high prevalence of epilepsy. This work reviews the main parasitic infestations causing epilepsy in the tropics. DEVELOPMENT Neurocysticercosis is the main cause of focal epilepsy in early adulthood in endemic areas (30-50%). All the phases of cysticerci (viable, transitional and calcified) are associated with epileptic seizures. Anti-cysticercus treatment helps get rid of cysticerci faster and reduces the risk of recurrence of seizures in patients with viable cysts. Symptomatic epilepsy can be the first manifestation of neuroschistosomiasis in patients without any systemic symptoms. The pseudotumoral form can trigger seizures secondary to the presence of granulomas and oedemas in the cerebral cortex. The eggs of Schistosoma japonicum are smaller, reach the CNS more easily and trigger epileptic seizures more frequently. Toxocariasis and sparganosis are other parasitic infestations that can give rise to symptomatic seizures. The risk factors for suffering chronic epilepsy after cerebral malaria are a positive familial history of epilepsy and a history of episodes of fever and cerebral malaria that began with coma or which progressed with multiple, prolonged epileptic seizures. About 20% of patients with cerebral infarction secondary to Chagas disease present late vascular epilepsy as a complication. CONCLUSIONS Very few studies have been conducted to examine the prognosis, risk of recurrence and modification of the natural course of seizures associated with tropical parasitic infestations, except for the case of neurocysticercosis.
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Affiliation(s)
- F J Carod-Artal
- Servicio de Neurología, Hospital Virgen de Luz, Cuenca, Espana.
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Poirier P, Brugières P, Liance M, Hosseini H, Perignon A, Botterel F. [Sciatica after return from Mali: case report of schistosomal myelopathy]. Med Trop (Mars) 2009; 69:295-297. [PMID: 19702157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION In spite of the high prevalence of schistosomiasis in Mali, few cases involving neurological complications have been described. The purpose of this report is to present a case associated medullary complications. CASE REPORT A 29-year-old man was hospitalized for low back pain and difficulty in walking linked to dysesthesia. Five months earlier the patient had been trreated for schistosomiasis contracted during a trip to Dogon region of Mali. Based on radiological and laboratory findings and previous clinical history, the difinitive diagnosis was schistosomal myelopathy. DISCUSSION/CONCLUSION Neuroschistosomiasis is a rare but serious complication of the schistosomiasis that can only be made after complete parasite identification and careful differential diagnosis. Treatment with antiparasitic agents in association with corticosteroids is mandatory but must only be initiated in state stage of the parasitic infection, i.e., after maturation of larvae into adults.
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Affiliation(s)
- P Poirier
- Service de Parasitologie-Mycologie, CHU Gabriel Montpied, Clermont-Ferrand, France
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Ahmed AF, Idris AS, Kareem AM, Dawoud TA. Acute toxemic schistosomiasis complicated by acute flaccid paraplegia due to schistosomal myeloradiculopathy in Sudan. Saudi Med J 2008; 29:770-773. [PMID: 18454231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
A 55-year old Sudanese physician presented with one month history of diarrhea, loss of weight (10 kg) and low grade nocturnal fever. Following colonoscopy, he rapidly developed paraparesis and retention of urine. Magnetic resonance imaging (MRI) of the spinal cord showed low cord lesion suggestive of transverse myelitis. We present a detailed account of diagnostic and management challenges and a literature review of the final diagnosis of acute toxemic schistosomiasis, complicated by acute flaccid paraplegia due to schistosomal myeloradiculopathy. We are reporting this case to increase the awareness of physicians of schistosomal myeloradiculopathy, as it needs urgent specific treatment praziquantel and steroids. An early follow-up with MRI of the spinal cord (2 weeks treatment) may help in preventing unnecessary neurosurgical intervention. Bilharziasis may be contracted on the banks of the river "White Nile" in urban areas. Finally, clinicians should make use of the Google computer search for diagnosis in difficult cases.
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Affiliation(s)
- Abdelmonim F Ahmed
- Department of Medicine, Faculty of Medicine, Taibah University, Al-Madinah Al-Munawarah. Kingdom of Saudi Arabia.
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Wichmann D, Hofmann C, Sudeck H, Burchard GD, Moser A. Myeloradiculitis: a rare event in schistosoma infection. Infection 2007; 34:349-51. [PMID: 17180592 DOI: 10.1007/s15010-006-5116-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Accepted: 02/20/2006] [Indexed: 11/28/2022]
Abstract
Schistosomiasis a parasitic disease caused by trematodes is widely distributed in (sub-)tropical countries. Depending on the species the infection manifests clinically as gastrointestinal (preferentially Schistosoma mansoni and S. japonicum) or urinary (preferentially S. haematobium) disorders. Here we present an uncommon case of myeloradiculitis leading to bladder palsy and sensory loss at the lower limbs.
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Affiliation(s)
- D Wichmann
- Clinical Department, Bernhard-Nocht-Institute for Tropical Medicine, Bernhard-Nocht-Str. 74, 20359, Hamburg, Germany.
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Andrade Filho AS, Queiroz AC, Freire ACC, Lima LCS, Filho CAS, Amado IN, Reis MG, Magalhães IF, Carmo TMA. Pseudotumoral form of neuroschistosomiasis: report of three cases. Braz J Infect Dis 2007; 11:435-8. [PMID: 17874001 DOI: 10.1590/s1413-86702007000400014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Indexed: 11/21/2022] Open
Abstract
Central nervous system (CSN) involvement in schistosomiasis is an ectopic manifestation with a large variety of clinical forms, including pseudotumoral, which occurs in isolated cases and is rare. Three patients with epidemiological indications of this pathology were examined; the clinical picture included lower-back pain irradiating to lower limbs, associated with progressive flaccid paraparesis and sphincterial disturbances in cases in which the spinal chord was involved; while in cases with encephalitic impairment, headache, dizziness and cerebellar syndrome, characterized by dysarthria and right-side dysgraphia, were present. Magnetic resonance imaging (MRI) showed a growing process in all cases; cerebrospinal fluid (CSF) characteristics and biological markers were compatible with neuroschistosomiasis (NS). Biopsy of the lesions confirmed this diagnosis in one case. After specific treatment with schistosomicides and corticosteroids, clinical, radiological and laboratorial improvement was observed.
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Affiliation(s)
- Mark Roberts
- Department of Infectious Diseases, Addenbrooke's Hospital, Cambridge, UK.
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Araújo KCGM, Rosa e Silva CD, Barbosa CS, Ferrari TCA. Clinical-epidemiological profile of children with schistosomal myeloradiculopathy attended at the Instituto Materno-Infantil de Pernambuco. Mem Inst Oswaldo Cruz 2006; 101 Suppl 1:149-56. [PMID: 17308763 DOI: 10.1590/s0074-02762006000900024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The most critical phase of exposure to schistosomal infection is the infancy, because of the more frequent contact with contaminated water and the immaturity of the immune system. One of the most severe presentations of this parasitosis is the involvement of the spinal cord, which prognosis is largely dependent on early diagnosis and treatment. Reports on this clinical form of schistosomiasis in children are rare in the literature. We present here the clinical-epidemiological profile of schistosomal myeloradiculopathy (SMR) from ten children who were admitted at the Instituto Materno-Infantil de Pernambuco over a five-year period. They were evaluated according to an investigation protocol. Most of these patients presented an acute neurological picture which included as the main clinical manifestations: sphincteral disorders, low back and lower limbs pain, paresthesia, lower limbs muscle weakness and absence of deep tendon reflex, and impairment of the gait. The diagnosis was presumptive in the majority of the cases. This study emphasizes the importance of considering the diagnosis of SMR in pediatric patients coming from endemic areas who present a low cord syndrome, in order to start the appropriate therapy and avoid future complications.
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Abstract
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.
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Affiliation(s)
- Alexander W Y Chen
- Department of General Medicine, Northampton General Hospital, Northampton NN1 5BD, United Kingdom
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Abstract
Abstract
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.
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Affiliation(s)
- Albert H Kim
- Department of Neurosurgery, Children's Hospital, Boston, Massachusetts 02115, USA.
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Marsaudon E, Kinay N, Destrieux C, Duong TH, Renaud C. Un ptosis palpébral révélateur d'une bilharziose du tronc cérébral. Rev Med Interne 2005; 26:600-2. [PMID: 15927317 DOI: 10.1016/j.revmed.2005.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Accepted: 03/12/2005] [Indexed: 11/26/2022]
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Rommel D, Ragé M, Duprez T, Parent M, Sindic CJM. Paucisymptomatic brainstem lesions revealing CNS schistosomiasis. Acta Neurol Belg 2005; 105:89-93. [PMID: 16076063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
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.
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Affiliation(s)
- D Rommel
- Department of Neurology, Cliniques universitaires Saint-Luc, B-1200 Brussels, Belgium
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Affiliation(s)
- José Roberto Lambertucci
- Serviço de Doenças Infecciosas, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Affiliation(s)
| | - Daniel Kremens
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Martin S. Wolfe
- George Washington University, Washington, DC
- Georgetown University, Washington, DC, USA
| | | | - Kevin M. Cahill
- Royal College of Surgeons, Dublin, Ireland
- New York University, New York, New York, USA
- Lenox Hill Hospital, New York, New York, USA
| | - Kevin Judy
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott Kasner
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily Blumberg
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Silva LCS, Maciel PE, Ribas JGR, Souza-Pereira SR, Antunes CM, Lambertucci JR. Treatment of Schistosomal Myeloradiculopathy with Praziquantel and Corticosteroids and Evaluation by Magnetic Resonance Imaging: A Longitudinal Study. Clin Infect Dis 2004; 39:1618-24. [PMID: 15578361 DOI: 10.1086/425611] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2004] [Accepted: 07/07/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The best treatment for schistosomal myeloradiculopathy (SMR) remains undefined. There is also no longitudinal study to estimate the value of magnetic resonance imaging (MRI) in the diagnosis and follow-up of this disease. METHODS Patients with the following presentation were considered for study: lumbar and/or lower limb pain; lower limb weakness; anesthesia, hypoesthesia, or paresthesia; bladder and/or intestinal dysfunction; and sexual impotence. Sixteen patients with SMR were treated with oral praziquantel (50 mg/kg in a single dose) and methylprednisolone (15 mg/kg/day intravenously for 5 days) followed by prednisone (1 mg/kg/day orally for 6 months). Clinical outcome was prospectively evaluated in months 2 and 6 of treatment. RESULTS Image alterations were detected by MRI at diagnosis for all patients, and normalization or improvement was reported at the end of treatment. There was statistically significant clinical melioration at both the second and sixth months of therapy for most neurological alterations. However, the best clinical outcome was achieved when the steroid was given for >2 months. CONCLUSIONS Treatment with praziquantel associated with corticosteroids was successful in all cases. MRI proved to be a good method for the diagnosis of SMR and helpful in the evaluation of response to treatment.
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Affiliation(s)
- Luciana C S Silva
- Infectious and Parasitic Diseases Branch, Medical School, University Hospital, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Abstract
The involvement of the central nervous system (CNS) by schistosomes may or may not determine clinical manifestations. When symptomatic, neuroschistosomiasis (NS) is one of the most severe presentations of schistosomal infection. Considering the symptomatic form, cerebral involvement is almost always due to Schistosoma japonicum and the spinal cord disease, caused by S. mansoni or S. haematobium. Available evidence suggests that NS depends basically on the presence of parasite eggs in the nervous tissue and on the host immune response. The patients with cerebral NS usually have the clinical manifestations of increased intracranial pressure associated with focal neurological signs; and those with schistosomal myeloradiculopathy (SMR) present rapidly progressing symptoms of myelitis involving the lower cord, usually in association with the involvement of the cauda esquina roots. The diagnosis of cerebral NS is established by biopsy of the nervous tissue and SMR is usually diagnosed according to a clinical criterion. Antischistosomal drugs, corticosteroids and surgery are the resources available for treating NS. The outcome is variable and is better in cerebral disease.
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Affiliation(s)
- Teresa Cristina de Abreu Ferrari
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, 30130-100 Belo Horizonte, MG, Brazil.
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Abstract
A mielorradiculopatia esquistossomótica é a forma ectópica mais grave e incapacitante da infecção pelo Schistosoma mansoni. A sua prevalência em área endêmica tem sido subestimada. O diagnóstico baseia-se na presença de sintomas neurológicos decorrentes de lesões da medula espinhal em nível torácico baixo e/ou lombar alto, na demonstração da infecção esquistossomótica por técnicas microscópicas ou sorológicas e na exclusão de outras causas de mielite transversa. O tratamento precoce, com esquistossomicidas e corticoesteróides, mostra-se eficaz na maioria dos casos e os pacientes não tratados não se recuperam ou morrem. Não há consenso sobre doses e duração do tratamento, mas estudo recente sugere que os corticoesteróides devam ser usados por pelo menos seis meses. Como o diagnóstico é presuntivo e o tratamento essencialmente clínico, há que se manter alerta para a presença da doença, aperfeiçoar a propedêutica e, dessa forma, evitar-se a laminectomia rotineira. Com o advento da ressonância magnética da medula espinhal houve grande avanço no diagnóstico da esquistossomose medular. Como conseqüência, o número de casos de mielopatia esquistossomótica relatados tem aumentado rapidamente.
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Affiliation(s)
- Luciana Cristina dos Santos Silva
- Serviço de Doenças Infecciosas e Parasitárias da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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24
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Rasamoelisoa JM, Tovone XG, Rakotovao E, Razafimandimby D, Andriambao D. [Bilharzian meningomyeloradiculopathy in children]. Arch Inst Pasteur Madagascar 2002; 66:36-8. [PMID: 12463032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Child meningomyeloradiculitis is a rare complication form of schistosomiasis, even in hyperendemic area. Its diagnosis is very difficult, especially if there are not history or signs of Schistosoma mansoni or hematobium infections. It must be evocated in case of acute flask paralysis occurring in children living in Schistosoma infections endemic area. The authors report a 14-year-old boy's case and suggest etiopathogeny of the disease.
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Affiliation(s)
- J M Rasamoelisoa
- Hôpital général de Befelatanana, Centre Hospitalier Universitaire d'Antananarivo, BP 14 bis-101 Antananarivo-Madagascar
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25
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Affiliation(s)
- Luciana C S Silva
- Serviço de Doenças Infecciosas e Parasitárias do Departamento de Clínica Médica da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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26
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Abstract
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.
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27
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Abstract
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.
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Affiliation(s)
- S Olson
- Townsville General Hospital, Eyre Street, North Ward, Townsville, Queensland, 4810, Australia.
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Nobre V, Silva LC, Ribas JG, Rayes A, Serufo JC, Lana-Peixoto MA, Marinho RF, Lambertucci JR. Schistosomal myeloradiculopathy due to Schistosoma mansoni: report on 23 cases. Mem Inst Oswaldo Cruz 2002; 96 Suppl:137-41. [PMID: 11586439 DOI: 10.1590/s0074-02762001000900020] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
Schistosoma mansoni infection is likely to be responsible for a significant proportion of cases of myelopathy occurring in areas where schistosomiasis is endemic. The aim of this study is to describe the clinical, laboratory and therapeutic data of 23 patients with schistosomal myeloradiculopathy. The medical records of 23 patients with schistosomal myelopathy admitted to two general hospitals of Belo Horizonte (MG), in Brazil, from 1995 to 1999, were reviewed retrospectively. Seventeen patients were male (74%). The mean age for the whole group was 27 years. Lower limb weakness and associated lumbar and/or lower limb pain were reported by 20 patients (87%), and 16 (70%) were unable to walk. All individuals presented urinary retention and 19 (83%) complained of intestinal dysfunction. The treatment was based on the association of antischistosomal drugs and corticosteroids. Five patients (22%) presented a full response to treatment, 13 (57%) partial response without functional limitations and 4 (17%) partial improvement with limitations or no response. Three out of the 4 patients who stopped steroids before 45 days of treatment developed recurrence of the symptoms and signs of myelopathy. Our cases demonstrate the severe presentation of the disease and the data disclosed here suggest that treatment with steroids should be kept for months after clinical improvement.
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Affiliation(s)
- V Nobre
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, 30130-100, Brasil
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29
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Leite CC, Souza AF, Valente M, Araujo MA, Jinkins JR. Clinics in diagnostic imaging (52). Spinal cord schistosomiasis. Singapore Med J 2000; 41:417-9. [PMID: 11256353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
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.
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Affiliation(s)
- C C Leite
- Department of Radiology, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
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