Abstract

LOPEZ, José Enrique et al. Paraplejía producida por schistosomiasis de la médula espinal: Presentación de 4 pacientes con estudio histopatológico. Gac Méd Caracas [online]. 2002, vol.110, n.2, pp.194-209. ISSN 0367-4762.

The authors reported four patients who where addmited to the Hospital Central, Valencia (Venezuela) suffering a spinal cord involvement by Schistosoma mansoni; in two cases the clinical manifestations were those of a myelomeningoradicular syndrome with complete paralysis of the lower limbs, muscular hypotrophy, Babinski sign, involvement of the urinary bladder and rectal sphinters beside objetive alterations of the sensibility. Another two patients developed spinal cord compression syndrome. Its was realized the Queckenstedt Stookey test and myelography were normal in two cases and in the others were consistent with arachnoiditis or intramedullary tumors. In the last case it was realized magnetic resonance imagin and it confirmed the presence of spinal cord compression with hyperintensive signals from T1 to T4, suggesting intramedullary spinal cord tumor. Histologic studies have shown to involve either a necrotizing myelitis or a granulomatous reaction about the ova. The granuloma formation is an immunologic reaction to the ova of a delayed hypersensitivity type. Therefore eggs in the spinal cord would not elicit a destructive response until the host had been sensitized and then rechallenged. This could produce a neurological deficit by either local tissue destruction or mass effect alone. All the patients were treated by surgical extirpation of granulomas, antischistosomal treatment: hycantone 3 mg/kg for one day and praziquantel 2 400 mg for one day (40 mg/kg day, for one day). Postulated modes of actions in the worm include blocking of metabolic pathways, such as inhibition of phosphofructokinase and specific organelle toxicity, such as vitellogenic gland destruction. Steroids has been used with unconvincing results but anecdotal accounts of improvement on initiation of steroid therapy justify treatment of Schistosoma myelopathy with dexametasona or oral prednisona as soon after diagnosis as possible. Medical papers on the subject were reviewed and clinical manifestations of spinal cord involvement by Schistosoma and its ova are pointed out: 1.Transversal myelitis, 2. Spinal cord compression syndrome, 3. Brown-Sequard syndrome, 4. Amyotrophic lateral sclerosis syndrome, 5. Poliradiculoneuritis similar to Guillain - Barre syndrome, 6. Schistosomiasis and anterior spinal artery occlusion.