Conus Medularis Neuroschistosomiasis In A 12-Year-Old Boy – A Case Report.

Abstract

Introduction: Neuroschistosomiasis is a rare manifestation of schistosomal parasitic infection. Majority of patients with neuro schistosomiasis present with progressively worsening motor and sensory function with sphincter dysfunction. Clinical history, examination, CSF studies, and imaging are key to the diagnosis of neuro schistosomiasis.  Patient Presentation: We report a case of a 12-year-old boy who presented with lower limb weakness and urine retention for  2 weeks from Machakos area. On examination the patient had reduced tone and areflexia of lower  limbs. The patient presented with a power grade of 0 in all lower limb muscle groups distal to the knee  and normal muscle bulk.  Diagnosis: Bilateral lower limb paralysis was associated with sensory loss in the L2 dermatome. A magnetic  resonance imaging (MRI) showed a tumor at the cauda equina region suggestive of a neurocytoma.  After surgery, the histopathologic results showed, schistosomal-associated necrotizing granulomatous inflammation of the tumor cells.  Interventions:  The patient underwent tumor resection surgery at the level of T1-L1 and was put on pain control medications and subsequently praziquantel after receipt of histopathology results.   Outcomes: The patient experienced clinical improvement and was discharged. Currently, he has paralysis distal to  the knee and is on follow-up at the neurosurgery clinic with ongoing physiotherapy and gets assistance from family in daily activities.  Conclusions: Our case underscores the importance of having a high index of suspicion in cauda equina tumors in  patients from Schistosoma endemic areas. Early diagnosis with CSF antibody titres, treatment with steroids and praziquantel is recommended. 

Abbreviations: CSF- Cerebrospinal Fluid