Brain Magnetic Resonance Imaging Findings in Young Patients with Hepatosplenic Schistosomiasis Mansoni without Overt Symptoms

Abstract

Abstract. The purpose of this study was to describe the brain magnetic resonance imaging (MRI) findings in young patients with hepatosplenic schistosomiasis mansoni without overt neurologic manifestations. This study included 34 young persons (age range = 9-25 years) with hepatosplenic schistosomiasis mansoni who had been previously treated. Patients were scanned on a 1.5-T system that included multiplanar pre-contrast and post-contrast sequences, and reports were completed by two radiologists after a consensus review. Twenty (58.8%) patients had MRI signal changes that were believed to be related to schistosomiasis mansoni. Twelve of the 20 patients had small focal hyperintensities on T2WI in the cerebral white matter, and eight patients had symmetric hyperintense basal ganglia on T1WI. There was a high frequency of brain MRI signal abnormalities in this series. Although not specific, these findings may be related to schistosomiasis.

Revisiting the concept of hepatosplenic schistosomiasis and its challenges using traditional and new tools

“…In my view, this increased incidence refl ects the improvement in its diagnosis with the advent of new imaging techniques, particularly MRI and the progressive awareness of its importance [58][59][60][61][62] .…”

Bacterial, Fungal, and Parasitic Infections of the Central Nervous System: Radiologic-Pathologic Correlation and Historical Perspectives:From the Radiologic Pathology Archives

“…In addition to granulomatous lesions, findings related to a portosystemic shunt may be seen as bilateral symmetric hyperintensity of the globus pallidus at T1-weighted imaging, and substantia nigra in hepatic schistosomiasis japonicum (even in the absence of liver dysfunction) has been observed and is believed to be related to manganese deposition (129). Findings in children and young adults with hepatosplenic schistosomiasis mansoni commonly include cerebral white matter hyperintensity at T2-weighted imaging and symmetric basal ganglia hyperintensity with rare corpus callosum involvement at T1-weighted imaging (129).…”

“…Most cases of cerebral schistosomiasis are caused by S japonicum, whereas spinal cord lesions are typically related to S mansoni and S hematobium (129,133). It is believed that the brain is involved through embolic distribution of the ova through venous shunts or by anomalous migration of adult worms, possibly through the vertebral venous (Batson) plexus (129,(133)(134)(135).…”

“…A major public health menace in developing countries, schistosomiasis is estimated to affect more than 200 million persons in Africa, Asia, and the Americas (129). Most human disease develops from infestation by one of three trematode worms-Schistosoma japonicum, Schistosoma mansoni, and Schistosoma hematobium-that live in certain freshwater snails (130,131), the larvae (cercariae) of which penetrate the skin in fresh water.…”

“…It is believed that the brain is involved through embolic distribution of the ova through venous shunts or by anomalous migration of adult worms, possibly through the vertebral venous (Batson) plexus (129,(133)(134)(135). S mansoni, which is endemic in Brazil and is more notoriously noted for substantial hepatosplenic disease (splenomegaly, periportal fibrosis, portal hypertension, and upper gastrointestinal bleeding from esophageal varices), less commonly affects the brain (26% in one series) (129,136). Fever, focal neurologic deficits, and seizures are typical clinical symptoms of cerebral schistosomiasis (133).…”