Neuroschistosomiasis: clinical symptoms and pathogenesis.

Neuroschistosomiasis, referring to schistosomal involvement of the CNS, when symptomatic, is a severe disorder in which prognosis depends largely on early diagnosis and treatment. It is an underdiagnosed disorder, but has been increasingly reported in populations in endemic areas and in tourists. CNS involvement can occur at any time during schistosomal infection. Both the brain and the spinal cord can be affected. Schistosoma mansoni and Schistosoma haematobium usually cause myelopathy, whereas Schistosoma japonicum usually causes encephalic disease. There are substantial differences in the pathogenesis, clinical presentation, and outcome of the neurological disorder, depending on the phase and clinical form of schistosomiasis in which it occurs.

Schistosomal myelopathy in childhood: findings of magnetic resonance imaging in 26 patients.

We describe magnetic resonance image findings of 26 children (16 boys; average age, 9.4 years) with schistosomal myelopathy. All children lived in Pernambuco State, Brazil, an area of endemic mansoni schistosomiasis. Imaging abnormalities were identified in 92.3% of the children. The most frequent findings included: (1) enlargement of the spinal cord at the thoracic level, usually below T(8), in 23/24 (96%) patients; (2) hypointense signals in T(1)-weighted imaging; (3) hyperintense signals in T(2) imaging; and (4) heterogeneous enhancement with gadolinium. Although enlargement was evident at the thoracic level, abnormal signals frequently extended to the lower cervical level, or inferiorly to the lumbar and sacral cord. Magnetic resonance imaging of the spinal cord can play a strong role in the investigation of children with schistosomal myelopathy. Although imaging abnormalities are not specific, their presence strengthens presumptive diagnoses, to expedite treatment and avoid invasive procedures.

Myeloradiculopathy associated to Schistosoma mansoni.

Neuroschistosomiasis caused by Schistosoma mansoni (Sm) is a rare and severe condition potentially leading to permanent neurological deficit. An 18-year-old Brazilian female was admitted due to a severe conus medullaris and cauda equina syndrome. MRI of thoracic/lumbar spine showed an expanded conus medullaris with patchy gadolinium-enhancement, needle electromyography revealed acute bilateral radiculopathy (L5-S1-S2), cerebrospinal fluid (CSF) showed lymphocytosis and increased proteins and lesion' surgical biopsy documented a lymphocyte infiltrate. Immunodiagnosis with cercariae hullen reaction using Sm cercariae in CSF and serum and immunoelectrodiffusion for circulating antigens detection using anti-Sm antibodies were positive. No schistosoma parasites were found. The patient was treated with praziquantel and corticotherapy for 6 months. At 1 month, partial clinical improvement was noticed, and MRI showed a normal size conus medullaris. At 6 months, there was complete clinical recovery. This case shows that a severe neurological deficit by Sm may have a clinical full recovery after treatment.

Research development of the pathogenesis pathways for neuroschistosomiasis.

The infection of the central nervous system (CNS) by schistosome may or may not have clinical manifestations. When symptomatic, neuroschistosomiasis (NS) is one of the most severe presentations of schistosome infection. Among the NS symptoms, cerebral invasion is mostly caused by Schistosoma japonicum (S. japonicum), and the spinal cord symptoms are mainly caused by S. mansoni or S. haematobium. There are 2 main pathways by which schistosomes cause NS: egg embolism and worm migration, via either artery or vein system, especially the valveless perivertebral Batson's plexus. The adult worm migrates anomalously through the above pathways to the CNS where they lay eggs. Due to the differences in species of schistosomes and stages of infection, mechanisms vary greatly. The portal hypertension with hepatosplenic schistosomiasis also plays an important role in the pathogenesis. Here the pathways through which NS occurs in the CNS were reviewed.

Esquistossomose do sistema nervoso central / Schistosomiasis mansonic case report of the central nervous system

A esquistossomose do Sistema Nervoso Central é relativamente pouco diagnosticada. Relatamos o caso de um paciente procedente de área näo endêmica, com manifestaçöes meningorradiculares da esquistosomose mansônica, comprovada por reaçäo de imunofluorescência no líquido cefalorraquidiano, tratado com praziquantel associado à corticoterapia. Ressaltamos a necessidade do diagnóstico etiológico específico e a instituiçäo precoce do tratamento com drogas antiinflamatórias e drogas específicas para a melhor recuperaçäo do paciente.