Cerebral granulomatous infection may also be caused by S. mansoni. In situ egg deposition following the anomalous migration of the adult worm, which appears to be the only mechanism by which Schistosoma can reach the central nervous system in people with schistosomiasis. The destructive action on the nervous tissue and the mass effect produced by a large number of eggs surrounded by multiple, large granulomas in circumscribed areas of the brain characterize the pseudotumoral form of neuroschistosomiasis and are responsible for the appearance of clinical manifestations: headache, hemiparesis, altered mental status, vertigo, visual abnormalities, seizures, and ataxia. Similarly, granulomatous lesions from S. mansoni and S. haematobium eggs in the spinal cord can lead to transverse myelitis (inflammation of the spinal cord) with flaccid paraplegia. In cases with advanced hepatosplenic and urinary schistosomiasis, the continuous embolization of eggs from the portal mesenteric system (S. mansoni) or portal mesenteric-pelvic system (S. haematobium) to the brain, results in a sparse distribution of eggs associated with scant periovular inflammatory reaction, usually with little or no clinical significance.Spinal cord inflammation (transverse myelitis) symptoms may include:

Paralysis of the lower extremities
Loss of bowel or urinary control
Loss of sensation below the level of the lesion
Pain below the level of the lesionCerebral granulomatous infection symptoms may include:

Seizures
Headaches
Motor impairment
Sensory impairment
Cerebellar symptomsUnsteady gait
Inability to stand or sit without support
Uncoordinated movements
Scanning speech
Irregular eye movementsCorticosteroids is used to prevent permanent neurological damage from the inflammatory response to the eggs, and sometimes anticonvulsant is needed to stop the seizures. Corticosteroid is given prior to administration of Praziquantel.
In one 6-year-old patient antibodies to GABA-producing enzyme glutamate decarboxylase were detected. See also
Stiff person syndrome

References


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