Spinal cord schistosomiasis

Clinical history
This 31-year-old nurse was born in Brazil and used to live in Brazil where, in March 1997 actually she developed a left drop foot that was attributed to a peroneal nerve compression at the level of the knee although the patient also complained from low back pain, sacroiliac pain, pain in the left leg and toes, a numbness in both feet. In April 1997, a lumbar CT was performed and a bulging disk diagnosed at the level of L4-L5. EMG showed an axonal lesion of the left peroneal nerve.
In May 1997 progressive paraparesis with bowel and bladder dysfunction occurred as well as saddle anesthesia and pain in both legs. In June 1997 the patient was transferred to Antwerp.

Neurological examination
Severe motor deficit at both lower limbs as well as sensory deficits were observed.

MR findings
Image 1: Sagittal PD Image.
Image 2: Sagittal T2WI. Mild enlargement of the conus with hyperintense lesion.
Image 3: Sagittal T1WI.
Image 4: Sagittal Gd T1WI: The lesion enhances strongly and is anteriorly located within the conus.
Image 5: Axial Gd T1W images show the enhancing lesion in the right part of the conus (arrow) as well as enhancement of the thickened nerve roots of the cauda equina (arrowheads).

The MRI findings suggested a myelitis. MRI of the brain was normal. Those findings urged to perform in this patient of Brazilian origin a full virological and parasitary screening, including a rectal biopsy, which revealed 4 typical Schistosomiasis eggs. Moreover, antibodies for Schistosomiasis were positive in blood and CSF samples.

Clinical follow-up
Appropriate treatment was given and good recovery occurred after 6 weeks with only slight residual left "drop foot" The patient could resume her normal activities, and no follow up MRI was clinically warranted.

Search also:
- Schistosomal myelitis

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