Neuroschistosomiasis is a serious complication of schistosomiasis, where Schistosoma parasites migrate to the central nervous system. It is often overlooked but can cause significant neurological symptoms. We present a 10-year-old male with headache and papilledema, emphasizing the importance of considering neuroschistosomiasis in patients with neurological symptoms and a history of schistosomiasis exposure. Early diagnosis and timely treatment with antischistosomal drugs and corticosteroids are crucial for positive outcomes. Raising awareness and implementing appropriate management approaches can improve the prognosis of neuroschistosomiasis.
Neuroschistosomiasis

INTRODUCTON: Schistosomiasis or snail fever is one of the important tropical disease problems. It is a long drawn debilitating disease closely related to the personal habits and livelihood requiring frequent contact with the fresh water. Morbidity and mortality due to schistosomiasis are known to reduce productivity that leads to heavy economic loss. Likewise it is known to claim 1.75 lives out of every 100 individuals afflicted with the disease, if left untreated. This paper emphasizes the importance of differential diagnosis of schistosomiasis in a patient who has spent time in an endemic area.CASE REPORT: A 56 year old agriculturist, Filipino male from Samar presented with progressive difficulty in urination, followed by numbness of perineal, gluteal and left posterior thigh accompanied by erectile dysfunction one month prior to admission. Digital rectal examination showed lax sphincteric tone and enlarged prostate. Neurological examination revealed hyperrdlexia of knee jerk, areflexia of ankle jerk and hypoesthesia of both feet and perineal area with bilateral mute toe. The rest of the findings were normal. Lumbosacral MRI showed heterogenons enhancing intramedullary mass lesion at the level of T12-L1 which involves the conus medullaris with cord edema. Laminectomy for intramedullary tumor at T12-L1 followed by rush frozen section was done. On opening, it was noted that the grayish intramedullary mass was noted at the L1 vertebral body. Rush frozen section showed intramedullary tumor consistent with malignant lymphoma. However, after further evaluation, the mass revealed schistosomiasis. Hence, he was then treated with Praziquantel.CONCLUSION: Schistosomiasis of the spinal cord should be considered in the differential diagnosis of lesions affecting the lower thoracic cord-conus medullaris and cauda equina in patients from endemic areas with history of exposure to Schistosomal infestation.
Human ; Male ; Middle Aged ; Schistosomiasis ; Parasitic Diseases ; Helminthiasis ; Trematode Infections ; Central Nervous System Parasitic Infections ; Central Nervous System Helminthiasis ; Diagnosis ; Spinal Cord ; Neuroschistosomiasis ; Lymphoma ; Neoplasms ; Neoplasms By Histologic Type

OBJECTIVETo describe the characteristic magnetic resonance imaging (MRI) appearance of cerebral schistosomiasis.

METHODSTwenty-five patients whose diagnosis of central nervous system (CNS) schistosomiasis had been pathologically (n = 8) and clinically (n = 17) confirmed were randomly selected. MRI was performed on a Signal 1. 5T MRI scanner before and after the intravenous administration of gadopentetate dimeglumine constrast medium. We reviewed the MRI studies obtained at the time of initial presentation, as well as follow-up studies obtained during and after medical treatment.

RESULTSImmunological tests in 15 patients indicated schistosomiasis haematobium. Contrast-enhanced T1-weighted images in 22 cases showed central linear enhancement surrounded by multiple enhancing punctate nodules, which appeared "arborized". Through operation and pathological examination, 8 cases had the granuloma formation of schistosomal eggs extensive surrounded by inflammation and venous congestion. And 17 cases were treated with praziquantel and corticosteroid therapy. And they were followed up for 2 months by taking MRI, which turned out to be complete resolution of the enhancing structure and edema. At follow-up, all the patients' initial symptoms also resolved.

CONCLUSIONThe specified MRI enhancement pattern of cerebral schistosomiasis is common in most cases of CNS schistosomiasis, so it should be taken account into the diagnosis of cerebral schistosomiasis.

Adolescent ; Adult ; Aged ; Brain ; pathology ; Brain Diseases ; diagnosis ; pathology ; Child ; Contrast Media ; Female ; Follow-Up Studies ; Gadolinium DTPA ; Humans ; Image Enhancement ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Neuroschistosomiasis ; diagnosis ; pathology ; Schistosomiasis haematobia ; diagnosis ; pathology

The central nervous system involvement of Schistosomiasis is rarely reported in the literatures. The authors report a case of cerebellar Schistosomiasis. A 40-year-old man presented to our hospital with a one year history of dizziness and gait disturbance. The computerized tomography and MRI of the brain and spinal cord showed tumoral form of mass on cerebellar vermis and roof of the fourth ventricle. The histological study of the partially excised cerebellar mass demonstrated granulomatous reaction around Schistosoma mansoni eggs. After operation, praziquantel was used for 7 days(60 mg/kg/day) drally. This is the first case report of central nervous system Schistosomiasis in Korea.
Adult ; Brain ; Central Nervous System ; Cerebellum ; Dizziness ; Eggs ; Fourth Ventricle ; Gait ; Humans ; Korea ; Magnetic Resonance Imaging ; Neuroschistosomiasis ; Ovum ; Praziquantel ; Schistosoma mansoni ; Schistosomiasis* ; Spinal Cord

To our knowledge, MR findings of neuroshistosomiasis has not been reported in Korea. A case of neuroshistosomiasis involving cerebellum and presumably spinal cord is reported. A 40 year old man who had lived in Middle East complained of low back pain and progressive paraparesis for 6 months, and subsequently developed headache, dizziness and diplopia. On cervical spine MRI, there was diffuse enlargement of cervical cord with increased signal intensity on T2 weighted image and nodular heterogenous enhancement after Gd-DTP^ administration. Brain MR imaging obtained 4 months later showed ill-defined, irregularly enhancing heterogenous mass in cerebellar vermis which was proved to be a granulomatous lesion containing shistosomiasis mansoni ova.
Adult ; Brain ; Cerebellum ; Diplopia ; Dizziness ; Granuloma* ; Headache ; Humans ; Korea ; Low Back Pain ; Magnetic Resonance Imaging* ; Middle East ; Myelitis, Transverse* ; Neuroschistosomiasis* ; Ovum ; Paraparesis ; Spinal Cord ; Spine