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Case 137

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A 27-year-old, born and foreseeing of Governador Valadares (inner city), employee of a bank, began to complain of back pain a week ago, which spread to the left leg and developed paresthesia in the lower limbs and urinary retention around 3 days ago. Her medical history was unremarkable. She denies any accidents, smoking and alcohol or drug intake. The patient reports frequent contact with natural waters in the region. Physical examination shows hypoesthesia on T12-L1 level, muscle strength with 4/5 score in the right lower limb and 3/5 score in the left one and hyperreflexia on both either.

What is the most likely diagnosis of this case, based on clinical history and problems detected on imaging test?

a) Multiple Sclerosis

25%

b) Schistosomal myeloradiculopathy

25%

c) Spinal Cord Tumor

25%

d) HTLV-1-associated Myelopathy (tropical spastic paraparesis)

25%
   

Comments

- The schistosomiasis infection can reach any part of the central nervous system (CNS). The Schistosomal myeloradiculopathy is one of the most common forms of the disease in CNS, occurring mainly in cases of schistosomiasis by specie Schistosoma mansoni.

- It is admitted that the eggs of the parasite and the worms reach the CNS through the Batson epidural venous plexus.  

- The involvement of the lower spinal cord, acute/subacute onset, and nerve roots involvement represent the most characteristic elements of that disease.

- The diagnosis is based on clinical history, on confirmation of the schistosomiasis infection and exclusion of other causes of myelopathy;

- The management of the patient is accomplished using praziquantel and corticosteroids. In selected cases, surgical procedure may be necessary.

References

- Ferrari ACT, Moreira RRP, Cunha SA. Spinal Cord schistosomiasis: a prospective study of 63 cases emphasizing clinical and therapeutic aspects. Journal of Clinical Neuroscience 2004; 11(3): 246-253.

- Silva SCL, Maciel EP, Ribas RGJ, Pereira SRS, Serufo CJ, Andrade ML, Antunes MC, Lambertucci RJ. Mielorradiculopatia esquistossomótica. Revista da Sociedade Brasileira de Medicina Tropical 2004; 37(3): 261-272.

- Ferrari ACT, Moreira RRP. Neuroschistosomiasis: clinical symptons and pathogenesis. Lancet Neuro 2011; 10: 853-64.

- Cecil RL, Goldman L. Cecil – Tratado de Medicina Interna. Rio de Janeiro: Elsevier Saunder; 2009: 2713-2719, 2761.

Authors

Janaína Chaves Lima, 5th year medical student at UFMG School of Medicine
E-mail: janaina-chaves[at]hotmail.com

Luciana Fonseca de Carvalho, 5th year medical student at UFMG School of Medicine
E-mail: lulu_decarvalho[at]yahoo.com.br

Supervisor

Prof Teresa Cristina de Abreu Ferrari, professor of the Department of Clinical Medicine at UFMG School of Medicine

E-mail: tferrari[at]medicina.ufmg.br 

Reviewers

Thaís Araújo, Marina Leão, Glauber Coutinho, Luana Monteiro, Prof Viviane Parisotto

Translated by

Hercules Hermes Riani Martins Silva, 4th year medical student at UFMG School of Medicine

E-mail: herculesriani[at]gmail.com

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