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Longitudinally Extensive Transverse Myelitis in Schistosomiasis - PowerPoint PPT PresentationTRANSCRIPT
Background
Although acute longitudinally extensive transverse
myelitis (LETM) is a key diagnostic component of
neuromyelitis optica (NMO) it may also occur in other
conditions such as multiple sclerosis, sarcoidosis and
infectious diseases. Schistosomiasis is a human trematode
infection affecting at least 200 million people in endemic
areas in Africa, South America, and Asia. Involvement of
the spinal cord may cause severe lumbar pain followed by
paraparesis associated with sensation and sphincter
disturbances. Such a clinical picture is frequently seen as
the first index event in NMO. Finding of a tumefactive
longitudinally extensive lesion on spinal MRI may further
confound the diagnosis. We report on three patients with
schistosomal myelitis and LETM.
Cases
Patients were a 21-YO black female, a 23-YO indian male,
and a 70-YO mulattoe male. All had lived for years in
endemic areas for schistosomiasis and had had contact with
contaminated water. The clinical presentation of the disease
was similar in all of them, and was characterized by lumbar
pain, followed by paraparesis, dysesthesia in the lower
limbs, and sphincter disturbances. Patient 3 was the only
one who had a previous diagnosis of intestinal and hepatic
schistosomiasis. All patients had positive stool examination
and rectal biopsy for ova of Schistosoma mansoni. Spinal
MRI disclosed in all three patients tumefactive T2-
weighted isointense or hyperintense, T1-weighted
hypointense gadolinium-enhanced
longitudinally extensive lesions. Lesions extended from
T4 to the conus medullaris in Patient 1; from T1 to T12
in Patient 2; and from T7 to T11 in Patient 3. Brain
MRI was unrevealing. Patients 1 and 2 did not respond
to treatment and remained wheelchair-bound, whereas
Patient 3 had a full recovery.
Figure. a. Case 2. Tumefactive T2-weighted lesion extending through the thoracic spinal cord. b. Case 3. T2-weighted hyperintense lesion extending from T7 to T11.
Conclusion
In endemic areas schistosomal myelitis should be included in the differential diagnosis of LETM. Neurologic outcome may depend on immune response of the host but prompt diagnosis and treatment may favor recovery.
Longitudinally Extensive Transverse Myelitis in Schistosomiasis
Juliana M.S.S. Amaral, Igor Ornelas, Natália C. Talim, Lívia E.C. Talim, Rodrigo Kleinpaul, Marcia Prates, Diogo C. Carvalho, Tauana S. Tironi, Izabela Duarte, Anderson Silva, Gisele O Lima, Carolina R. Araujo, Cristiane F. Rocha,
Marco A. Lana-Peixoto.CIEM MS Research Center, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil.
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