Cervical spinal cord schistosomiasis

Silva, Luciana C.S.; Kill, Cleverson Martins; Lambertucci, José Roberto

doi:10.1590/s0037-86822002000500023

Cited by 24 publications

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“…Peregrino et al 8 reported that in 66.6% of their patients just the conus medullaris was involved, and no case of cervical involvement was described. Damage to the cervical segment has been described as very rare 12 , but Valença 13 reported its occurrence and concluded that it is imperative to examine all segments using MRI among SM patients.…”

Section: Discussionmentioning

confidence: 99%

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

Vidal¹,

Ferreira²,

Filho³

et al. 2012

Arq. Neuro-Psiquiatr.

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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.

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Section: Discussionmentioning

confidence: 99%

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

Vidal¹,

Ferreira²,

Filho³

et al. 2012

Arq. Neuro-Psiquiatr.

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“…However, in the case of our patient, it is difficult to choose an explanation for the spinal cord involvement. No biopsy of the spinal cord to confirm the presence of Schistosoma mansoni eggs 30 was available and hence associated vasculitis cannot be ruled out 33 . It is worth mentioning that there was extensive involvement of the spinal cord in the case presented here (the lesion extended from T1 to T11, as documented by magnetic resonance imaging), which was followed by severe spinal cord atrophy 25 .…”

Section: Discussionmentioning

confidence: 99%

Simultaneous occurrence of brain tumor and myeloradiculopathy in schistosomiasis mansoni: case report

Lambertucci

Souza-Pereira

Carvalho

2009

Rev. Soc. Bras. Med. Trop.

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Simultaneous occurrence of brain tumor and myeloradiculopathy in cases of Manson's schistosomiasis have only rarely been described. We report the case of a 38-year-old man who developed seizures during a trip to Puerto Rico and in whom a brain tumor was diagnosed by magnetic resonance imaging: brain biopsy revealed the diagnosis of schistosomiasis. He was transferred to a hospital in the United States and, during hospitalization, he developed sudden paraplegia. The diagnosis of myeloradiculopathy was confirmed at that time. He was administered praziquantel and steroids. The brain tumor disappeared, but the patient was left with paraplegia and fecal and urinary dysfunction. He has now been followed up in Brazil for one year, and his clinical state, imaging examinations and laboratory tests are presented here. Key-words:Brain tumor. Neuroschistosomiasis. Myeloradiculopathy. RESUMOTem sido descrita, raramente, na esquistossomose mansônica, a ocorrência simultânea de tumor cerebral e mielorradiculopatia. Relatamos aqui o caso de um homem de 38 anos que desenvolveu convulsões, durante viagem a Porto Rico, e um tumor cerebral foi diagnosticado à ressonância magnética: a biópsia do cérebro revelou o diagnóstico de esquistossomose. Ele foi transferido para hospital na América do Norte e durante a hospitalização desenvolveu súbita paraplegia. O diagnóstico de mielorradiculopatia foi confirmado na ocasião. Ele recebeu praziquantel e esteróides. O tumor cerebral desapareceu, mas o paciente permaneceu com paraplegia, disfunção urinária e fecal. Ele tem sido acompanhado no Brasil no último ano e o seu estado clínico, os métodos de imagem e os exames de laboratório são apresentados aqui. Palavras-chaves:Tumor cerebral. Neuroesquistossomose. Mielorradiculopatia. Neurological involvement is associated with infection by the three main species of Schistosoma (Schistosoma mansoni, Schistosoma japonicum and Schistosoma haematobium) 1 2 9 11 13 21 . Although myeloradiculopathy is the most common neurological complication of Schistosoma mansoni infection, the prevalence of cerebral and spinal cord schistosomiasis is unknown. Neuroschistosomiasis is probably underdiagnosed, underestimated and underreported 8 12 14 .Severe neurological involvement has been described during the early post-infective stage in non-immune patients 10 15 . Acute encephalitis and cerebral vasculitis have been reported during primary infection with Schistosoma mansoni 9 28 . Asymptomatic neuroschistosomiasis appears to be more frequent in association with the more severe chronic forms of Schistosoma mansoni. A Brazilian autopsy case series revealed scattered ova of Schistosoma mansoni in 25% of the brains of patients (without neurological deficit) who died due to hepatosplenic schistosomiasis 24 .Schistosoma mansoni can also cause a brain tumor-like syndrome due to slowly expanding cerebral and cerebellar lesions 4 6 15 18 23 24 26 27 .Schistosomal myeloradiculopathy is the most severe and disabling ectopic form of Schistosoma mansoni infection 11 13 1...

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“…These authors suggest that the unique "arborized" appearance of the linear and nodular enhancement pattern may constitute a new sign for the diagnosis of CNS schistosomiasis. Besides the enhancement of the medullar signal on MRI, a fine, diffuse, nodular contrast enhancement after gadolinium administration was described on the report of the fifth published case of cervical NS that was confirmed by biopsy of the spinal cord 55 . PEREGRINO et al 41 reported that 88.8% of 18 patients with spinal NS presented weighted images and heterogenous pattern of enhancement with contrast material injection.…”

Section: Diagnosismentioning

confidence: 94%

Neuroschistosomiasis due to Schistosoma mansoni: a review of pathogenesis, clinical syndromes and diagnostic approaches

Nascimento‐Carvalho

Moreno-Carvalho²

2005

Rev. Inst. Med. trop. S. Paulo

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SUMMARYNeuroschistosomiasis (NS) is the second most common form of presentation of infection by the trematode, Schistosoma mansoni. Granulomatous inflammatory reaction occurs as a result of schistosome eggs being transmitted to spinal cord or brain via the vascular system, or by inadvertent adult worm migration to these organs. The two main clinical syndromes are spinal cord neuroschistosomiasis (acute or subacute myelopathy) and localized cerebral or cerebellar neuroschistosomiasis (focal CNS impairment, seizures, increased intracranial pressure). Presumptive diagnosis of NS requires confirming the presence of S. mansoni infection by stool microscopy or rectal biopsy for trematode eggs, and serologic testing of blood and spinal fluid. The localized lesions are identified by signs and symptoms, and confirmed by imaging techniques (contrast myelography, CT and MRI). Algorithms are presented to allow a stepwise approach to diagnosis.

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Cervical spinal cord schistosomiasis

Cited by 24 publications

References 0 publications

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

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

Simultaneous occurrence of brain tumor and myeloradiculopathy in schistosomiasis mansoni: case report

Neuroschistosomiasis due to Schistosoma mansoni: a review of pathogenesis, clinical syndromes and diagnostic approaches

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