Extensive spinal cord involvement in magnetic resonance imaging evaluation on schistosomal myelitis

Abstract

Schistosomiasis is a serious public health problem in some regions of the world. It is endemic in more than 74 countries and accounts for the majority of the cases of portal hypertension among the young population in these areas. Around the world, it is believed that there are about 200 million people infected by the Schistosoma species S. mansoni, S. haematobium, S. japonicum, S. intercalatum and S. mekongi 1,2 .The temporal clinical and systemic forms of the disease are: acute (toxemic and non-toxemic), latent and chronic 2,3 . The latter is divided into mild forms (intestinal and hepaticintestinal) and severe forms (hepatosplenic, pulmonary and glomerular) 2,3 .The presence and clinical significance of neurological lesions depend on the combination of the presence of eggs in the nervous system and the immune response of the host. In the majority of cases, a type IV or granulomatous delayed immune response occurs, and the response is greater in the earlier phases of schistosomiasis. In chronic forms, it becomes localized and attenuated (immunological modulation phenomenon) 4,5 . ABSTRACTThe diagnosis of schistosomal myelitis (SM) is frequently presumptive because no findings from any complementary examination are pathognomonic for this disease. The present report describes some abnormalities seen on magnetic resonance imaging (MRI) evaluation of a series of SM patients and discusses their etiopathogenesis. Methods: This study evaluated SM patients at the time of their diagnosis. These patients routinely underwent MRI on all segments of the spinal cord. Results: Thirteen patients were evaluated. The MRI was abnormal in 12 (92.3%) of them. In 11 patients (84.61%), the damage reached two or more spinal segments. Conclusions: MRI was an important diagnostic aid in this sample, because of the high rate of abnormalities detected. The tissue damage observed on MRI was extensive in the majority of the patients.Key words: Schistosoma mansoni, neuroschistosomiasis, myelitis, magnetic resonance imaging, diagnosis. RESUMOO diagnóstico da mielite esquistossomótica é frequentemente realizado por presunção, não havendo achado de exame complementar que seja patognomônico à condição. O presente estudo descreve alterações presentes na avaliação desses pacientes pela técnica da ressonân-cia magnética e discute sua etiopatogênese. Métodos: O estudo avaliou pacientes com mielite esquistossomótica no momento do diagnós-tico, os quais foram submetidos, rotineiramente, à ressonância magnética de todos os segmentos medulares. Resultados: Foram avaliados 13 pacientes, sendo a ressonância magnética alterada em 92.3% dos casos. Em 11 pacientes (84.61%), o dano abrangeu dois ou mais segmentos espinais. Conclusões: A ressonância magnética espinhal foi um importante auxílio diagnóstico nessa casuística em virtude da alta taxa de alterações detectadas. O dano tecidual observado foi extenso na maioria dos pacientes.Palavras-Chave: Schistosoma mansoni, neuroesquistossomose, mielite, imagem por ressonância magnética, diagnóstico.

Mielorradiculopatia esquistossomótica associada a infecção pelo vírus HBV: relato de caso

“…No caso relatado, observamos lesão medular extensa acometendo praticamente todo o eixo medular. Lesões extensas são tidas como atípicas para a infecção por S. mansoni, contudo, em estudo realizado por Vidal et al 28 mostraram em sua casuística que cerca de 50% dos casos de mielite por S. mansoni foram caracterizados como acometimento extenso da medula em praticamente toda sua extensão. O processo patológico, que poderia justificar a extensão da lesão, seria o envolvimento da deposição à distância de imunocom-plexos decorrentes da reação imunológica ao ovo do parasita e não somente pela reação granulomatosa local ao redor dos ovos28.…”

The role of magnetic resonance imaging in the management of schistosomal myeloradiculopathy

“…Vidal et al 8 , in the present issue of Arquivos de Neuro-Psiquiatria, draw attention to a less common MRI picture in SMR. The presence of extensive cord compromise, manifested by T2-hyperintensity involving the whole spinal cord or its thoracic and lumbar regions, was appreciated in 10 out of 12 patients with MRI abnormalities; diffuse enhancement was found in eight of them, somewhat heterogeneous but distinct to the above described patterns.…”