Presentation
This patient had complaints of lumbar and lower limb pain, with paresthesias, associated with bladder and intestinal dysfunction.
Patient Data
Thoracic and lumbar spine MRI shows slight/moderate enlargement of the distal cord and conus medullaris, at D12. The lesion is isointense to the cord in T1-weighted images, with hyperintense patches in T2 images. There is a heterogeneous pathological contrast enhancement in T1 WI sequences, with linear and multiple scattered punctate nodules, forming a granular or arborized pattern of impregnation at the expanded distal spinal cord and conus. This arborized pattern of enhancement is consistent with spinal cord schistosomiasis.
Case Discussion
Spinal cord schistosomiasis is a serious but treatable presentation of Schistosoma mansoni infection 1,2. Early diagnosis and rapid therapy are fundamental for the prevention of irreversible neurological sequelae 1,2.
This case illustrates the typical MRI granular pattern of enhancement of schistosomal myeloradiculopathy at the distal cord and conus medullaris. The evidence of exposure to this parasitic was by rectal biopsy with positive histopathologic study for Schistosoma mansoni. This patient responded to praziquantel and steroid therapy and recovered well.
Case courtesy
- Erick Cavalcanti, MD - PGY-3, Radiology Resident, Department of Radiology
- Antonio Rodrigues de Aguiar Neto, MD - Radiologist, Department of Radiology
- Hospital da Restauração – Recife, PE – Brazil
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