Massive Spinal Cord Necrosis in Schistosomiasis

Queiróz, Luciano de Souza; Nucci, Anamarli; Facure, Nubor O.; Facure, José Jorge

doi:10.1001/archneur.1979.00500440087021

Cited by 36 publications

(11 citation statements)

References 15 publications

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“…O aumento da pressão intrabdominal em episódios frequentes ou por períodos prolongados, relacionado com certas profissões, pode exercer papel facilitador na fisiopatogenia da EM. O grau de imunidade natural e adquirida, assim com o grau de infestação, podem explicar a baixa incidência da EM em comparação à população de esquistossomóticos existentes em nosso país, como também a multiplicidade de formas clínicas, diferentes tipos de evolução e de respostas ao tratamento 9,13,14,21 .…”

Section: Resultsunclassified

Esquistossomose medular: análise de 80 casos

Peregrino

Puglia

Nobrega

et al. 2002

Arq. Neuro-Psiquiatr.

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RESUMO -O objetivo deste estudo é analisar dados clínicos e laboratoriais de 80 casos de esquistossomose medular (EM) que possam contribuir para melhorar o diagnóstico e tratamento dessa doença. Em 59 pacientes o estudo foi de maneira prospectiva, em 79 pacientes o diagnóstico foi catalogado como altamente provável, presuntivo, baseado em critérios clínico e laboratoriais. Em um paciente houve confirmação anatomo-patológica. Houve predominância do sexo masculino (63,7%), faixa etária entre 21 e 40 anos (63,7%), procedência nordestina (85%), trabalhador em construção civil (31,2%), esforço abdominal prévio (57,5%), início subagudo (61,2%), forma clínica mielorradiculítica e lesão no cone medular e cauda equina (72,5%). O estudo do líquido cefaloraquidiano mostrou pleocitose e taxas elevadas de proteínas em 100% dos casos, da gamaglobulina em 76.5%, positividade de reações imunológicas específicas (imunofluorescência e/ou ELISA) em 100% dos casos (titulo médio de 1/16 e 61u/dl, respectivamente). Costicosteróides e drogas esquistossomicidas foram administrados em todos os pacientes com evolução satisfatória em 80% dos casos. ABSTRACT -To outline through cinical-laboratorial analysis a profile of schistosomiasis of the spinal cord (SSC) that contributes to the diagnosis and treatment of this disease. 80 patients were studied (59 prospectively), and epidemiological, clinical,laboratorial, treatment and outcome data extracted. In 79 patients the diagnosis was presumptive and obeyed rigorous criteria. There was a predominance of male sex (68.7%), age group from 21 to 40 years (63.7%), Northeasterners (85%), building construction workers (31.2%), previous abdominal effort (57.5%), subacute beginning (61.2%), myeloradiculitis form and lesion in conus and cauda equina (72.5%). Cerebral spinal fluid showed lymphomononuclear pleocytosis and protein increase in 100% of the cases as well as gamma globulin in 76.5%, positiveness of immunofluorescence reaction and/or ELISA for schistosomiasis in 100% of the cases with average titles of 1/16 and 61 u/dl, respectively. Corticosteroids and antischistosomal drugs were given to all patients with a satisfactory outcome in 80% of the cases. We emphasize the importance of a precocious treatment to avoid irreversible deficits such as paraplegia or sexual impotence. PALAVRAS-CHAVE

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Section: Resultsunclassified

Esquistossomose medular: análise de 80 casos

Peregrino

Puglia

Nobrega

et al. 2002

Arq. Neuro-Psiquiatr.

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“…No biopsy of the spinal cord to confirm the presence of Schistosoma mansoni eggs 30 was available and hence associated vasculitis cannot be ruled out 33 . It is worth mentioning that there was extensive involvement of the spinal cord in the case presented here (the lesion extended from T1 to T11, as documented by magnetic resonance imaging), which was followed by severe spinal cord atrophy 25 .…”

Section: Discussionmentioning

confidence: 57%

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

Lambertucci

Souza-Pereira

Carvalho

2009

Rev. Soc. Bras. Med. Trop.

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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. Key-words:Brain tumor. Neuroschistosomiasis. Myeloradiculopathy. RESUMOTem 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. Palavras-chaves:Tumor cerebral. Neuroesquistossomose. Mielorradiculopatia. Neurological involvement is associated with infection by the three main species of Schistosoma (Schistosoma mansoni, Schistosoma japonicum and Schistosoma haematobium) 1 2 9 11 13 21 . Although myeloradiculopathy is the most common neurological complication of Schistosoma mansoni infection, the prevalence of cerebral and spinal cord schistosomiasis is unknown. Neuroschistosomiasis is probably underdiagnosed, underestimated and underreported 8 12 14 .Severe neurological involvement has been described during the early post-infective stage in non-immune patients 10 15 . Acute encephalitis and cerebral vasculitis have been reported during primary infection with Schistosoma mansoni 9 28 . Asymptomatic neuroschistosomiasis appears to be more frequent in association with the more severe chronic forms of Schistosoma mansoni. A Brazilian autopsy case series revealed scattered ova of Schistosoma mansoni in 25% of the brains of patients (without neurological deficit) who died due to hepatosplenic schistosomiasis 24 .Schistosoma mansoni can also cause a brain tumor-like syndrome due to slowly expanding cerebral and cerebellar lesions 4 6 15 18 23 24 26 27 .Schistosomal myeloradiculopathy is the most severe and disabling ectopic form of Schistosoma mansoni infection 11 13 1...

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“…He was discharged from hospital after 6 weeks without any residual neurological deficit, and normal cerebrospinal fluid (Table I). To date we have found 64 cases reported in the literature (Table II) (Norfray, Tahar, 1972;Queiroz, Nucci, Facure, Facure, 1979;Dar, Zimmerman, 1977;Pool, 1978Pool, -1979Lechtenberg,Vaida, 1977;Luyendijk, Lindeman, 1975;Wood, Srolovitz, Schetman, 1976;Saxe, Gordon, 1975;EI-Banhawy, 1971;Scaff, Riva, 1971;Nozias, Pichard, Develoux, Gentilini, 1983;Chait, Gannon, 1969;Warren, 1973;Eftimiou, Denning, 1984;Adeloye, Folami. Aghadiung, 1982;Levy, 1970;Ghaly, EI-Banhawy, 1973;Siddorn, 1978;Ibrahim, 1941;Sparrow, 1966;Arean, 1966;Scully, Mark, McNealy, 1985).…”

Section: Case Reportmentioning

confidence: 99%