Cervical intramedullar schistosomiasis as a rare cause of acute tetraparesis

Introduction: the trematode infection schistosomiasis affects at least 200 million people in endemic areas. Granulomas cause the typical manifestation s of urogenital, intestinal and hepatolienal schistosomiasis. Involvement o f other organs especially the central nervous system (CNS) is uncommon. Cas e Report: we describe a 40-year old male with a history of repeated contact with schistosome contaminated water. After having suffered from flu-like s ymptoms with fever and arthralgies, he first presented with a polyradiculop athy of unknown origin. Then 4 weeks later an acute tetraparesis occurred. Spinal magnetic resonance imaging (MRI) revealed a spinal stenosis and quer y medullary hyperintensities at C6-C8 without contrast-enhancement. Serolog ic testing was positive for schistosomiasis. The intraoperative appearance at decompressive laminectomy revealed a myelitic form of schistosomiasis. U nder therapy with praziquantel, initially high dose cortison and intensive physiotherapy symptoms slowly improved over months. On follow-up 1 year lat er, the patient presented with a spastic distally marked tetraparesis and s ensory impairment from C6 downwards. Conclusion: cervical intramedullar sch istosomiasis is a rare cause of acute tetra- or para-paresis in patients, w ho have had contact with schistosomes. Early diagnosis is essential because of the excellent prognosis with specific therapy. (C) 2001 Elsevier Scienc e B.V. All rights reserved.