Schistosomiasis of the spinal cord: report of 5 cases from Sudan.

Schistosomiasis of the spinal cord is an uncommon but potentially curable form of schistosomiasis, if diagnosed and managed early. The spinal cord is more frequently affected in Schistosoma mansoni or S. haematobium infections. This paper describes the clinical manifestations, diagnosis and management of schistosomiasis of the spinal cord in 5 patients attending Shaab and Ibn Khuldoun Hospitals, Khartoum from 1997 to 2007. There were 4 males and 1 female aged 9-45 years. They presented with symptoms and signs due to cord compression at the lower thoracic and lumbar vertebrae. Imaging studies revealed intramedullary masses compressing the cord. Biopsy showed ova of S. mansoni with surrounding inflammatory reaction. The cord showed demyelination near the ova and an associated inflammatory reaction. Patients responded well to surgical ecompression and treatment with praziquantel and oral steroids.

Surgical treatment of cerebellar schistosomiasis.

OBJECTIVE: To explore the surgical treatment of cerebellar schistosomiasis. METHODS: Twelve cases of cerebellar schistosomiasis treated in our department were analyzed retrospectively. RESULTS: All cases were cured. At the 2-year follow-up examination, all patients could perform physical tasks normally. CONCLUSION: Cerebellar schistosomiasis tends to cause mass effect of the posterior cranial fossa and increased intracranial pressure. Microresection of the pathological focus and decompression of the posterior cranial fossa should be effective therapeutic measures.

Diagnóstico intraoperatório de esquistossomose mansônica cerebelar pseudotumoral / Intraoperative diagnosis of pseudotumoral cerebellar neuroschistosomiasis

A esquistossomose é uma doença parasitária causada por vermes trematódios do gênero Schistosoma. Esses vermes habitam ramos da veia mesentérica inferior e, por meio da ovoposição, disseminam seus ovos por várias regiões do organismo humano. O sistema nervoso central (SNC) pode ser afetado no decorrer de qualquer forma clínica da infecção, principalmente pela embolização dos ovos ocorrida após a migração anômala dos vermes adultos para locais próximos ao tecido cerebral. No SNC, os ovos induzem reação granulomatosa periovular intensa, respondendo pela produção do efeito de massa com sinais neurológicos de aumento de pressão intracraniana. É relatado o caso de um homem de 27 anos cujo diagnóstico de esquistossomose mansônica cerebelar foi obtido pelo método de esmagamento linear (squash), durante o ato cirúrgico. Uma biópsia retal realizada posteriormente confirmou a presença de ovos viáveis de S. mansoni. No conhecimento dos autores, este é o primeiro relato de neuroesquistossomose diagnosticado por esta técnica.

Schistosomiasis is a parasitic infection caused by trematode platyhelminths of the genus Schistosoma. These worms live in branches of the inferior mesenteric vein and disseminate its eggs to several regions of the human organism through circulation. Central nervous system (CNS) involvement may occur in the development of any clinical infection, mainly by in-situ egg deposition following anomalous migration of adult worms to sites near the cerebral tissue. The presence of eggs in the CNS induces a severe periovular granulomatous reaction, which is responsible for the mass effect and the increased intracranial pressure. A case of cerebellar schistosomiasis caused by S. mansoni in a 27-year-old man is diagnosed by squash (smear) technique. A rectal biopsy performed later showed viable S. mansoni eggs. This is, probably, the first report of neuroschistosomiasis diagnosed by the squash (smear) technique.

Schistosomiasis mansoni presenting as a cerebellar tumor: case report.

The Manson's schistosomiasis tumoral form rarely affects the brain. There are only 12 cases prior related with a mean age of 25 years and a male predominance. We describe a 16-year-old Brazilian Northeastern boy with a cerebellar mass lesion. The radiological aspect was considered compatible with glioma and a gross total resection was performed. Microscopic examination disclosed intraparenchymal granulomas surrounding Schistosoma mansoni eggs. The case is compared with the literature findings and some peculiar aspects of this trematode infection are reviewed.

Schistosomiasis mansoni presenting as a cerebellar tumor: case report

The Manson's schistosomiasis tumoral form rarely affects the brain. There are only 12 cases prior related with a mean age of 25 years and a male predominance. We describe a 16-year-old Brazilian Northeastern boy with a cerebellar mass lesion. The radiological aspect was considered compatible with glioma and a gross total resection was performed. Microscopic examination disclosed intraparenchymal granulomas surrounding Schistosoma mansoni eggs. The case is compared with the literature findings and some peculiar aspects of this trematode infection are reviewed.

A forma pseudotumoral da esquistossomose mansônica raramente acomete o encéfalo. Apenas 12 casos foram previamente descritos com idade média de 25 anos e predominância do sexo masculino. Relatamos um caso em paciente do nordeste brasileiro de 16 anos portador de lesão expansiva cerebelar. O aspecto radiológico foi considerado compatível com tumor cerebelar primário e ressecção radical realizada. Estudo histopatológico demonstrou granulomas intraparenquimatosos contornando ovos de Schistosoma mansoni. O caso é comparado com os achados da literatura e aspectos peculiares dessa neuropasitose são discutidos.

[The tumoral form of cerebellar schistosomiasis: case report and measure of granulomas]. / Forma tumoral da esquistossomose mansoni cerebelar: relato de caso e medida dos granulomas.

An unusual case of the tumoral form of cerebellar Schistosomiasis mansoni, in a 15 year-old male diagnosed by biopsy, with neurological signs and symptoms 60 days prior to surgery. Computerized tomography show a hyperdense expanding lesion located in cerebellum, suggesting glioma. Histopathological examination showed numerous S. mansoni ova involved by granulomatous inflammation in necrotic-exudative phase, located mainly in the internal, granular layer of the cerebellum, creating a pseudotumor in the cerebellar vermis and a recent hemorrhage in the trunk. The areas of granulomas were measured.

Forma tumoral da esquistossomose mansoni cerebelar: relato de caso e medida dos granulomas / The tumoral form of cerebellar schistosomiasis: case report and measure of granulomas

Caso raro de forma tumoral da esquistossomose mansoni cerebelar diagnosticada pela biópsia, em um paciente de 15 anos, que apresentou sinais e sintomas neurológicos 60 dias antes da cirurgia. A tomografia computadorizada revelou lesão expansiva, hiperdensa, localizada no cerebelo, sugestiva de glioma. O exame histopatológico mostrou numerosos ovos de S. mansoni envolvidos por reação inflamatória granulomatosa na fase necrótico-exsudativa, confluentes, localizados principalmente na camada interna, granular, do cerebelo, formando pseudotumor no verme cerebelar e hemorragia recente na ponte. Foram medidas as áreas dos granulomas.

Spinal cord schistosomiasis: MR imaging appearance with surgical and pathologic correlation.

BACKGROUND AND PURPOSE: Spinal cord involvement is a rare manifestation of schistosomiasis. We describe the MR imaging findings of spinal cord schistosomiasis in correlation with surgery and pathology. METHODS: We report eight cases of spinal cord schistosomiasis. All patients were men (mean age, 16.7 years) with neurologic manifestations who had been referred for spinal MR imaging. In all cases, spinal masses were surgically removed. MR imaging findings were correlated with surgery and pathology. RESULTS: MR imaging showed moderate expansion of the distal spinal cord in all cases. Abnormalities were isointense to cord in T1 and patchy hyperintense in T2-weighted spin-echo images (n = 8). Three forms of contrast enhancement were recognized: (1) intramedullary nodular (n = 8); (2) peripheral (n = 8); and (3) linear radicular (n = 4). Total gross surgical removal of masses by using the Cavitron ultrasonic surgical aspirator was possible in six cases. Diagnosis was established by identification of ova in histopathologic studies: Schistosoma mansoni (n = 3), S. hematobium (n = 1), and uncertain species (n = 4). Intramedullary nodular enhancement was correlated to multiple schistosomiasis microtubercles. Peripheral enhancing lesions correlated to thickened leptomeninges infested by chronic granulomatous inflammatory cells and schistosoma eggs. Linear radicular enhancement correlated with thickened resected nervous roots infested by granulomatous cells and schistosoma eggs. CONCLUSION: Multinodular intramedullary contrast enhancement of the distal cord enabled correct presumptive preoperative MR imaging diagnosis of spinal schistosomiasis in three cases. Accurate diagnosis, through recognition of its MR imaging appearance, allows early treatment and better prognosis of spinal cord schistosomiasis.

[Cerebellar schistomiasis. A case report]. / La bilharziose cérébelleuse. A propos d'un cas.

Schistomiasis or bilharziosis remains an endemic parasitic disease in many countries world wide. Urogenital, intestinal and hepatic symptoms are common. The brain is exceptionally involved and very few cases have been described in the literature. We report the case of a 35-Year-old male with a history of hematuria and bladder disorders, who developed signs of intracranial hypertension and a cerebellar syndrome over a period of one Month. Brain MRI disclosed a cerebellar lesion and a pelvic CT scan revealed a bladder tumor. Treatment consisted in a ventriculo-peritoneal shunt and corticosteroid therapy. Cystoscopy was performed for total resection of the bladder lesion. Histopathology confirmed the diagnosis of schistomiasis. Surgery was also performed to approach the cerebellar lesion. Histopathology showed the inflammatory nature of the lesion. The patient was given an antiparasitic treatment. Clinical and radiological radiological manifestations regressed.

Intramedullary schistosomiasis.

A case study of intramedullary schistosomiasis in a 10-year-old child is reported. The patient presented with a short history of ascending paraparesis with no sensory loss. Sphincter dysfunction was rapid. She had surgical exploration and removal of a conus medullaris mass. Schistosomiasis was confirmed histologically. Combined steroid and praziquantel therapy improved her sphincter function and paraparesis.

[Schistosomiasis of the spinal cord. Case report]. / Esquistosomiasis medular. Presentación de un caso clínico.

The authors report a case of a 34 year-old woman who, in the last four years, had travelled to Africa frequently, and developed a progressive clinical (about three months) dysfunction of the conus medullaris mainly consisting in sensitive disturbances. The MRI showed an intramedullary spinal cord lesion, and specific laboratory tests were negative. A biopsy for histologic diagnosis, showed a granulomatous tissue with eggs of S. Hematobium. After this diagnosis she was treated with praziquantel. We emphasize the relative frequency of the spinal cord location of schistosomiasis in endemic countries, and the importance of the laboratory diagnosis to start an early and effective antischistosomal treatment. Spinal cord schistosomiasis is uncommon but we must bear in mind this possibility in patients with a progressive spinal cord afectation.

Schistomiasis of the spinal cord: report two cases.

Schistosomiasis affects over 200 million people worldwide. Schistosomiasis of the spinal cord is a rare occurrence. In Africa, there have been recent reports from Egypt and South Africa. In Uganda, the last histological records were over two decades ago. Schistosomiasis of the spinal cord is commonly caused by Schistosoma mansoni although Schistosoma haematobium has been isolated. Two case reports are presented. In both patients, the diagnosis was made retrospectively. The first patient was a female patient with a lesion in the thoracic region. The second patient was a 21 year old male with a lesion in the conus. Apart from a block on the myelograms, all other laboratory investigations were negative. The diagnosis was made histologically in both cases with the identification of eggs of schistosoma in the spinal cord. The eggs could however, not be retrieved from the stool or urine samples. Both patients were treated with antischistosomal drugs and steroids. On follow up they had marked improvement in their neurological signs. We hope to renew attention in this rare but devastating neurological manifestation of a disease which affects many in our region and which if left untreated can lead to permanent neurological damage.

Spinal cord schistosomiasis / Neuroesquistossomose medular

The authors present a case of spinal cord schistosomiasis which simulated a tumoral lesion determining spastic paraparesis with a sensitive-motor level at T1. The patient was treated with surgery, praziquantel and dexamethasone, with ?restitutio ad integrum?. Seven years later the patient presented recrudescence of the symptoms, without a good response to the medication and without a plausible explanation. The authors wonder about the reasons of the low incidence of central nervous system schistosomosis in an endemic area such as the Northeast of Brazil. Abrief review of the literature is done.

Os autores apresentam um caso de esquistossomose medular simulandoprocesso tumoral, manisfestando-se com paraparesia espástica e nívelsensitivo em T1. O tratamento cirúrgico, complementado pela administraçãode praziquantel e dexametasona, proporcionou recuperação total do quadro neurológico. Após sete anos, houve recidiva dos sintomas, de causa não totalmente esclarecida e sem resposta ao tratamento medicamentoso. Chamam atenção à baixa incidência de neuroesquistossomose em regiões endêmicas, como o Nordeste do Brasil.