Spinal cord schistosomiasis: a prospective study of 63 cases emphasizing clinical and therapeutic aspects

Clinical-epidemiologic profile of the schistosomal myeloradiculopathy in Pernambuco, Brazil

“…In a study by Moreira (1998), which included 12 cases, the following findings were described: paresthesia in 25% of the patients, urinary dysfunction in 100%, constipation in 50% and lumbar pain in 54.5%. The prevalence of hypo-anaesthesia as a manifestation of SMR has been reported in several studies , Ferrari 1997, Ferrari et al 2004.…”

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

“…In the aforementioned review, the level of the lesion was described in 214 (92.6%) of 231 cases reviewed and the frequency was: low thoracic (T6-T12) 41.6%, lumbar 33.2%, lumbar, sacral and cauda equina 9.8%, high thoracic (T1-T5) 7.0%, sacral 5.1%, radicular (cauda equina) 1.9% and cervical 1.4% 13 . In a series of prospectively evaluated 63 cases with presumptive spinal NS, FERRARI et al 17 reported progressive worsening with new clinical manifestation being added to the previous one; nevertheless, spontaneous improvement of pain was observed in some patients as the remaining manifestations set in; the myeloradicular symptoms were maximal within two weeks of their onset in most cases (69.8%), particularly within the first week. Four clinical forms of spinal NS are classically described: granulomatous (expansive lesion due to granulomatous reaction around the eggs and destruction of adjacent tissue), myelitic (necrosis, vacuolization and atrophy of the nervous tissue with scarce granulomas, presenting as progressive transverse myelitis with adverse outcome), radicular (granulomas are formed on the surface of the nerve roots, mainly in the cauda equina and patients present asymmetric sensory and motor disturbance), vascular (immunological inflammation of the anterior spinal artery) 13,56 .…”

“…In a Brazilian series of 377 patients presumptively diagnosed with NS, hypercellularity was present in 66%, protein concentration increase was identified in 84.6% and eosinophils were present in 46.9% 33 . FERRARI et al prospectively studying 63 patients with presumptive spinal NS found abnormal CSF (high protein concentration and/or pleocytosis) in 93.7%, total protein concentration higher than 45mg/ dL in 87.3%, pleocytosis in 81.0% and presence of eosinophils in 57.1% 17 . CAROD-ARTAL & VARGAS have recently reported two cases with presumptive diagnosis of NS: one presented CSF pleocytosis, eosinophils, high protein levels and IgG positive for S. mansoni in CSF and other with a normal CSF study 8 .…”

“…The presumptive diagnosis of spinal NS according to the Centers for Disease Control and Prevention requires evidence of a low medullary lesion and/ or a lesion of the cauda equina, confirmation of schistosomiasis by stool parasitological examination and/or rectal biopsy or positive serological tests for schistosome and exclusion of other causes of the myeloradicular damage 10 . However, several authors have rejected the confirmation of schistosomal infection by serology since false-positive results are common because antibodies against schistosomal antigens can crossreact against antigens from other agents, particularly helminthes 17 . SANTOS et al 52 have proposed a classification for the probability of spinal NS: possible when there are low thoracic or lumbar/sacral spinal cord compromise and positive epidemiology for schistosomiasis; probable when besides the aforementioned criteria there are demonstration of schistosomal infection by parasitological methods and exclusion of other possible causes; confirmed when there is histopathological study of the CNS demonstrating the presence of S. mansoni ova or worm.…”

Forma tumoral da esquistossomose mansoni cerebelar: relato de caso e medida dos granulomas

“…Ocorre principalmente na medula espinhal 10 , sendo responsável por cerca de seis 27 a 13,4% 7 das mielopatias nas áreas endêmicas, não ultrapassando de 200 o número de casos descritos na literatura 17 .…”