RESUMO
Abstract The most common neurological impairments related to schistosomiasis involve the lower portions of the medulla and the cauda equina. A 22-year-old woman, with no history, signs, or symptoms of hepatointestinal schistosomiasis, presented with lumbar pain associated with acute paresthesia and paresis of the right lower limb. Spinal schistosomiasis was suspected based on the disease progression and radiological findings, and the diagnosis was confirmed after cerebrospinal fluid analysis. The authors emphasize this pathology as important as a differential diagnosis in similar clinical scenarios, especially in endemic areas, because both early diagnosis and treatment are essential to avoid permanent sequelae.
Assuntos
Humanos , Feminino , Adulto Jovem , Radiculopatia/diagnóstico , Neuroesquistossomose/diagnóstico , Radiculopatia/líquido cefalorraquidiano , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/líquido cefalorraquidiano , Imageamento por Ressonância Magnética , Neuroesquistossomose/líquido cefalorraquidiano , Diagnóstico DiferencialRESUMO
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.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Neuroesquistossomose/diagnóstico , Anti-Helmínticos/uso terapêutico , Dexametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Imageamento por Ressonância Magnética , Neuroesquistossomose/líquido cefalorraquidiano , Neuroesquistossomose/tratamento farmacológico , Praziquantel/uso terapêutico , Prednisona/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
As três espécies de esquistossoma podem comprometer o sistema nervoso. O S. mansoni é responsável pela esquistossomose no Brasil, sendo a mielopatia uma forma grave desta helmintose. O propósito deste trabalho é analisar as alterações do líquido cefalorraquidiano (LCR) para dar mais subsídios para o diagnóstico da esquistossomose raquimedular. Fizeram parte deste estudo 22 amostras de LCR de pacientes com esquistossomose espinal. Os resultados das análises destas amostras mostraram que a associação de alterações do LCR com quadro inflamatório e RIFI-IgM positiva ocorreu em 88 por cento dos pacientes, que o eosinófilo esteve presente em apenas 7 amostras (36,8 por cento), e que 3 dos 22 pacientes estudados apresentaram LCR normal. Conclui-se que o exame de LCR é coadjuvante muito útil para o diagnóstico da neuroesquistossomose.