Schistosomiasis of the conus medullaris

Case contributed by Dalia Ibrahim
Diagnosis certain


Bilateral lower limb weakness, sensory loss as well as urinary and stool incontinence.

Patient Data

Age: 15 years
Gender: Male

Expansion of the conus which shows intramedullary increased signal extending to the lower half of the dorsal cord (up to D7). At the post-contrast series, it shows intramedullary central conus and lower dorsal cord intramedullary anterior peripheral nodular and patchy enhancement in an arborized pattern (evident on the T1 fat sat C+ series). Also, mild thickening and enhancement of the cauda equina nerve roots.

Case Discussion

This case illustrates the typical MRI involvement of the spinal cord schistosomiasis which mainly involves the conus medullaris as a typical location and the characteristic granular/arborized pattern of enhancement of schistosomal myeloradiculopathy at the distal cord and conus medullaris. The patient clinically complained of severe urinary schistosomal infection. CSF analysis revealed elevated protein content and oligoclonal IgG bands. Positive Schistosoma antibody titer (Ab). This patient responded rapidly to praziquantel and steroid therapy.

Neuroschistosomiasis with involvement of the central nervous system (CNS) include the brain and spinal cord. The spinal cord is frequently affected by S. mansoni, and cerebral schistosomiasis (CS) is most frequently affected by S. japonicum 1.

Spinal cord schistosomiasis often has a predilection to the lower spinal cord and conus medullaris which shows expansion and abnormal signal 1.

Three different forms of abnormal intraspinal contrast enhancement: 1

  • intramedullary nodular enhancement

  • peripheral enhancing lesions on the cord surface

  • enhancing thickened nerve roots and cauda equina

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