Are seizures associated with neuroschistosomiasis mansoni? An exploratory survey in an endemic area of Brazil.

BACKGROUND: Deposition of Schistosoma mansoni eggs in the brain of patients with hepatosplenic schistosomiasis (HS-SM) is frequent and usually asymptomatic. However, it is questioned whether it could cause seizures. Thus, we investigated the occurrence of seizures in these patients and also searched for parameters associated with this disorder. METHODS: In a cross-sectional survey, we compared 128 patients with HS-SM with 102 patients with portal hypertension due to compensated chronic hepatic disease of other etiologies. A standardized questionnaire, emphasizing epilepsy-related parameters, was applied to all participants. RESULTS: Eight (6.3%) patients with HS-SM had a history of seizures, whereas this condition was reported by three (2.9%) individuals from the comparison group (p=0.354). None of the variables were associated with the occurrence of seizures, either in univariate or in multivariate analysis. CONCLUSIONS: The frequency of seizures was similar in both study groups. However, it was higher than that described in population-based studies. Thus, we hypothesize that HS-SM individuals may have a higher frequency of seizure. The lack of difference between the two study groups may be explained by the inclusion of cases of HS-MS overlapping other chronic liver diseases in the comparison group, because this finding is relatively common in schistosome-endemic areas.

Prevalence of urodynamic changes with risk for upper urinary tract damage in neuroschistosomiasis patients.

INTRODUCTION: This study aimed to identify the prevalence of urodynamic changes with an associated risk of developing upper urinary tract damage in neuroschistosomiasis patients. METHODS: A prospective study was conducted, wherein68 patients were admitted for analysis of urodynamics, urea and creatinine levels, and uroculture. RESULTS: Blood test results did not indicate kidney failure. There were cases of asymptomatic bacteriuria. Common symptoms were frequent nocturia and detrusor overactivity. Results of low compliance and low cystometric capacity were both statistically significant (p = 0.001 and p = 0.002, respectively). CONCLUSIONS: A high prevalence of negative urodynamic changes were found in neuroschistosomiasis patients.

Prevalence of urodynamic changes with risk for upper urinary tract damage in neuroschistosomiasis patients

Abstract INTRODUCTION: This study aimed to identify the prevalence of urodynamic changes with an associated risk of developing upper urinary tract damage in neuroschistosomiasis patients. METHODS: A prospective study was conducted, wherein68 patients were admitted for analysis of urodynamics, urea and creatinine levels, and uroculture. RESULTS: Blood test results did not indicate kidney failure. There were cases of asymptomatic bacteriuria. Common symptoms were frequent nocturia and detrusor overactivity. Results of low compliance and low cystometric capacity were both statistically significant (p = 0.001 and p = 0.002, respectively). CONCLUSIONS: A high prevalence of negative urodynamic changes were found in neuroschistosomiasis patients.

You're the Flight Surgeon.

Elliott T. You're the flight surgeon: rapid onset of weakness. Aerosp Med Hum Perform. 2018; 89(11):1013-1015.

[Myelitis transversa caused by neuroschistosomiasis]. / Myelitis transversa door schistosomiasis.

BACKGROUND: Neuroschistosomiasis is a severe complication of an infection with Schistosoma; this infection can lead to myelitis transversa. Acute myelitis transversa is a rare disorder of the spinal cord, which can present with muscular weakness, sensory disturbance and intestinal or bladder dysfunction. CASE DESCRIPTION: A 17-year-old refugee from Eritrea, who had been in the Netherlands for 3 weeks, suffered from back pain and progressive weakness of both legs for one week. Both the clinical presentation and the MRI images were consistent with myelitis transversa. Schistosomamansoni eggs were found in the faeces, and antibodies to Schistosoma eggs and worms were found in both liquor and serum, leading to a diagnosis of neuroschistosomiasis. The patient recovered completely following treatment with praziquantel and prednisone. CONCLUSION: Schistosomiasis is a commonly occurring parasitic disease in sub-Saharan Africa, which can lead to myelitis transversa if it spreads to the spinal cord. Early detection and treatment are necessary to prevent lasting damage. A good geographical case history is essential for this process.

Delayed presentation of cerebral schistosomiasis presenting as a tumor-like brain lesion.

Schistosomiasis is the second most common parasitic infection worldwide. North America is a nonendemic area. However, there are occasional case reports among travelers and immigrants from endemic regions. We describe a case of a 55-year-old Canadian woman who presented with first episode of seizure. Her magnetic resonance imaging scan revealed a mass-like lesion involving the left anterior temporal lobe. The lesion showed T1 hypo- and T2 hyperintense with perilesional brain edema. On post-gadolinium-enhanced T1-weighted sequence, the lesion showed multiple small nodular and linear enhancements, also called an "arborized" appearance. Initially, the lesion was thought to be a malignant tumor. She underwent left anterior temporal lobe resection. Histologic examination showed parasitic eggs with a characteristic lateral spine consistent with Schistosoma mansoni infection. Upon subsequent questioning, it was revealed that the patient lived in Ghana from the ages of 8-10 years and she visited Ghana again 10 years prior for two weeks. She recalled swimming in beaches and rivers. Latent disease, as in this case with presentation, many years or decades after presumed exposure is rare but has been reported. Characteristic magnetic resonance imaging findings may suggest the diagnosis and facilitate noninvasive work-up.

Neuroschistosomiasis.

Neuroschistosomiasis, the infection of the CNS by Schistosoma spp., is a neglected and under-recognized complication of schistosomiasis. Cerebral and spinal neuroschistosomiasis can provoke severe disability. Neurological symptoms occur as a consequence of the immune reaction around the eggs deposited in the CNS. Cerebral neuroschistosomiasis may present with altered sensorium, headache, seizures and focal neurological deficit. Pseudotumoral and cerebellar neuroschistosomiasis may provoke intracranial hypertension and hydrocephalus. Brain-enhancing lesions with associated mass effect can be observed on MRI. Transverse myelitis and myeloradiculopathy affecting the conus medullaris and/or cauda equina are the most common spinal cord syndromes. Transverse myelitis can present as flaccid arreflexic paraplegia with sensory level and sphincter dysfunction. Praziquantel and corticoids have been successfully used to treat neuroschistosomiasis. Ventricle-peritoneal shunt may be necessary to treat hydrocephalus associated with tumor-like brain and/or cerebellar schistosomiasis.

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

This was a retrospective descriptive study on a series of cases of schistosomal myeloradiculopathy (SMR) and the aim was to investigate the incidence of this disease and its clinical and epidemiological characteristics in cases diagnosed at three healthcare units in Pernambuco, Brazil between 1994-2006. The data were collected by reviewing the medical records from both the neurological and paediatric outpatient clinics and wards of the Hospital Clinics, Hospital of the Restoration and Pernambuco Mother and Child Institute. To gather the data, a spinal cord schistosomiasis evaluation protocol was used. The diagnoses were based on positive epidemiological evidence of schistosomiasis, clinical findings and laboratory tests (stool parasitological examination or rectal biopsies, magnetic resonance imaging findings and cerebrospinal fluid investigations). A total of 139 cases aged between 2-83 years were found. The most important determinants of SMR were male sex (66.2%), contact with fresh water (91%), origin in endemic regions (39.5%), lower-limb muscle weakness (100%), sensory level at the lower thoracic medulla (40.3%), myeloradicular form (76%) and presence of eggs in the stool parasitological examination (48%). This sample indicates the need for intervention policies guided by diagnostic standardization, thereby avoiding disease under-notification.

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.

A bilateral foot drop due to neuroschistosomiasis.

Schistosomiasis is a parasitic disease, uncommon in Europe and the USA. We present an unusual case of intracerebral schistosomiasis, presenting with a bilateral foot drop. We describe unique magnetic resonance spectroscopy characteristics that can contribute to diagnosis and follow up of a neuroschistosomiasis infection.

[Tropical causes of epilepsy]. / Causas tropicales de epilepsia.

INTRODUCTION: Eighty-five percent of all epileptics live in tropical regions. Prenatal risk factors, traumatic brain injuries and different parasitic infestations of the central nervous system (CNS) are the reasons behind the high prevalence of epilepsy. This work reviews the main parasitic infestations causing epilepsy in the tropics. DEVELOPMENT: Neurocysticercosis is the main cause of focal epilepsy in early adulthood in endemic areas (30-50%). All the phases of cysticerci (viable, transitional and calcified) are associated with epileptic seizures. Anti-cysticercus treatment helps get rid of cysticerci faster and reduces the risk of recurrence of seizures in patients with viable cysts. Symptomatic epilepsy can be the first manifestation of neuroschistosomiasis in patients without any systemic symptoms. The pseudotumoral form can trigger seizures secondary to the presence of granulomas and oedemas in the cerebral cortex. The eggs of Schistosoma japonicum are smaller, reach the CNS more easily and trigger epileptic seizures more frequently. Toxocariasis and sparganosis are other parasitic infestations that can give rise to symptomatic seizures. The risk factors for suffering chronic epilepsy after cerebral malaria are a positive familial history of epilepsy and a history of episodes of fever and cerebral malaria that began with coma or which progressed with multiple, prolonged epileptic seizures. About 20% of patients with cerebral infarction secondary to Chagas disease present late vascular epilepsy as a complication. CONCLUSIONS: Very few studies have been conducted to examine the prognosis, risk of recurrence and modification of the natural course of seizures associated with tropical parasitic infestations, except for the case of neurocysticercosis.

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

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.

[Sciatica after return from Mali: case report of schistosomal myelopathy]. / Sciatique au retour du Mali.

INTRODUCTION: In spite of the high prevalence of schistosomiasis in Mali, few cases involving neurological complications have been described. The purpose of this report is to present a case associated medullary complications. CASE REPORT: A 29-year-old man was hospitalized for low back pain and difficulty in walking linked to dysesthesia. Five months earlier the patient had been trreated for schistosomiasis contracted during a trip to Dogon region of Mali. Based on radiological and laboratory findings and previous clinical history, the difinitive diagnosis was schistosomal myelopathy. DISCUSSION/CONCLUSION: Neuroschistosomiasis is a rare but serious complication of the schistosomiasis that can only be made after complete parasite identification and careful differential diagnosis. Treatment with antiparasitic agents in association with corticosteroids is mandatory but must only be initiated in state stage of the parasitic infection, i.e., after maturation of larvae into adults.

The worm that turned.

When a patient presents with acute myelopathy in the developed world, helminthic infection is not routinely considered in the differential diagnosis. We report the case of a 34-year-old South African male who presented with acute urinary retention and lower leg paraesthesiae. Subsequently, myeloradiculopathy secondary to Schistosoma mansoni was diagnosed on the basis of typical magnetic resonance imaging changes in the conus medullaris and positive stool microscopy. Prior to this presentation the patient had lived in urban western South Africa and more recently in New Zealand, without exposure to infected water for 22 years. His symptoms and signs resolved following treatment with praziquantel and methylprednisolone. Spinal schistosomiasis is a rare but serious cause of myelopathy and should be considered in any patient who has ever visited or lived in an endemic area.

Simultaneous occurrence of brain tumor and myeloradiculopathy in schistosomiasis mansoni: case report / Ocorrência simultânea de tumor cerebral e mielorradiculopatia na esquistossomose mansoni: relato de caso

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.

Tem 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.

Intramedullary schistosomiasis presenting in an adolescent with prolonged intermittent back pain.

A 14-year-old boy traveling from Guinea presented with a 2-month history of stable lower back pain. His neurologic examination was significant only for mild weakness in the distal lower extremities. He manifested peripheral eosinophilia, and magnetic resonance imagining revealed enlargement of the caudal aspect of the spinal cord and conus. A presumptive diagnosis of spinal schistosomiasis was rendered, and appropriate medication was administered before obtaining positive serology results. The patient's signs rapidly resolved. Spinal schistosomiasis should be considered in the differential diagnosis of any child with back pain and an appropriate travel history.

Acute neuroschistosomiasis: two cases associated with cerebral vasculitis.

Encephalitis and focal neurologic deficits can occur during the acute phase of schistosomiasis. We report two cases in which cerebral imaging showed cerebral vasculitis located in arterial junctional territories. These neurologic complications may be caused by eosinophil-mediated toxicity. Immediate treatment should consist of corticosteroids rather than specific antischistosomal drugs, which may aggravate the disorders.