THUR 132 Neuroschistosomiasis: complication of a neglected tropical disease

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Abstract

Neuroschistosomiasis is an under-recognised complication of one of the world’s most prevalent, yet neglected parasitic diseases, which if left untreated can result in severe disability. Although schistosomiasis is most commonly found in the tropics, neurologists in developed countries must have a low index of suspicion in the appropriate clinical setting.

We describe a 17 year old previously fit and well Guinean lady presenting with subacute, progressive, symmetric lower limb hyperaesthesia and urinary retention. Neurological examination was consistent with a myeloradiculopathy. Initial tests revealed an eosinophilia and raised ESR. CSF and imaging findings supported the clinical diagnosis of myeloradiculopathy secondary to schistosomiasis. She responded well to empirical steroids and praziquantel with complete resolution of sensory and urinary symptoms over several weeks. Serology later confirmed the diagnosis.

Transverse myelitis and myeloradiculopathy affecting the conus medullaris and/or cauda equina are the most common presentations associated with neuroschistosomiasis. Symptoms are principally due to an inflammatory response to the retained schistosome eggs. This case details the differential diagnosis of a subacute myeloradiculopathy and highlights the importance of a thorough travel history. In the appropriate clinical context, neuroschistosomiasis should be included in the differential diagnosis of a subacute myeloradiculopathy, enabling prompt diagnosis and optimal management.

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