Dados do Trabalho

Título

Cerebral schistosomiasis: na importante differential diagnosis of brain tumor

RESUMO

CASE PRESENTATION: A 24-year oldpatient, without comorbidities, started to present in March 2021 with seizures. He was admitted to the servisse with a neurological examination without alterations, but when performing a cranial tomography, hypodensity was observed in the right parieto-occipital region, being hospitalized due to the initial clinical suspicion of a brain tumor, lateron a cranial resonance that showed a swollen lesion involving the subcortical White matter. Of the right superior frontal gyrus, characterized by hypersignalonT2/FLAIR sequences and with tiny nodular foci with hyposignal and intense post-gadolinium enhancement, without diffusion restriction. In the evaluation of the cérebro spinal fluid, there were no changes in cellularity, proteins and glucose, and it was not possible to perform immunology due to unavailability in the service. Based on the findings of the imaging exam, the possibility of cerebral schistosomiasis was raised and a biopsy was performed, which showed the presence of Schistosoma mansoni eggs. Treatment with praziquantel and corticosteroid was performed. Patient evolves with neurological examination without alterations and with out new episodes of seizures.
DISCUSSION: Schistosomiasis of the central nervous system (CNS) is relatively rare, being called neuroschistosomiasis (NE). It occurs mainly in the spinal cord, accounting for about 6 to 13.4% of myelopathies in endemic areas. Intracranial localization, notably in the cerebral hemispheres, is much rarer. NE can be clinically manifested by meningo myeloradiculitis, myelitis, radiculitis, or by the cerebralor medullary pseudotumor form. The most common presenting symptoms are cognitive impairment, headache, seizures, and focal neurologic deficits.
FINAL COMMENTS: NE with cerebral involvementis very rare, but it should Always be suspected in patients with images suggestive of tumors and who live in endemic areas. Early and adequate treatment is of Paramount importance to minimize CNS tissue damage and prevent chronic sequelae.

Palavras Chave

neuroschistosomiasis; seizures; Schistosomiasis