What is the clinical evidence of Schistosomal myeloradiculopathy?
The clinical evidence of Schistosomal myeloradiculopathy is when there is positive epidemiology for schistosomiasis; the patient has a dysfunction of the low thoracic or high lumbar spinal cord; laboratory demonstration of exposure to schistosomiasis by serological techniques, parasitological stool examination or rectal biopsy; and elimination of other etiologies of transverse myelitis.
What are the signs and symptoms of spinal cord schistosomiasis?
The spinal schistosomal disease causes acute or subacute myeloradiculopathy, with signs and symptoms of transverse myelitis involving the lower spinal cord segments. The clinical manifestations may include lumbar pain and lower limb pain, lower limb weakness, paresthesia, paraparesis, bladder, and intestinal dysfunction, and sexual impotence in men.
Which is the most specific test for the detection of schistosomiasis?
The most specific test for schistosomiasis is the detection of Schistosoma eggs in feces, or tissue biopsy (rectal mucosa, bladder mucosa, skin or medullary tissue).
What are the MRI findings in patients with spinal cord schistosomiasis?
MRI is essential in the diagnosis of spinal cord schistosomiasis, allowing identification of enlargement of the distal cord and conus medullaris, with high signal intensity on T2-WI, and heterogeneous pathological enhancement in T1 WI sequences, with a granular or arborized pattern of contrast impregnation.
What is the treatment for spinal cord schistosomiasis?
The treatment of schistosomal myeloradiculopathy is primarily clinical with schistosomicidal drugs and corticosteroids. Surgery is for patients with acute paraplegia and obstruction of CSF, who need spinal canal decompression.
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.