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Abstract：
BACKGROUND: Schistosomiasis is a parasitic infection that commonly affects the gastrointestinal and genitourinary tracts. Cerebral schistosomiasis is rare, and few operative cases have been reported in the literature. Diagnosis is usually challenging due to the similarity of the lesion to many other brain conditions. Treatment usually requires surgical resection combined with the use of antiparasitic agents, which often results in good outcomes and excellent prognosis.
METHODS: A 24-year-old, previously healthy Afro-asiatic man presented to our neurosurgical outpatient clinic complaining of headache and an attack of convulsions. On examination, he had bilateral lower limb weakness more on the right side. Laboratory investigations including stool and urine general test results were unremarkable. Magnetic resonance imaging of the brain was performed and showed an intra-axial left parietal mass; a granulomatous lesion was suggested in the differential diagnoses. The patient underwent craniotomy and total resection of the lesion. Histopathology confirmed the presence of active cerebral Schistosoma mansoni infection. Orally administered praziquantel was initiated at a dose of 20 mg/kg twice a day for a total of 3 days along with oral administration of corticosteroids for 2 weeks. The patient improved postoperatively without residual weakness and with no further convulsions.
CONCLUSIONS: Cerebral schistosomiasis is a rare but important consideration in the list of differential diagnoses of cerebral space-occupying lesions. This is of particular importance in in endemic areas like Sudan. In order to reach a diagnosis, careful social and occupational history need to be obtained and correlated with the clinical, laboratory, and radiological findings. Surgical resection along with the use of proper antiparasitic agents usually provides the best clinical outcomes.
METHODS: A 24-year-old, previously healthy Afro-asiatic man presented to our neurosurgical outpatient clinic complaining of headache and an attack of convulsions. On examination, he had bilateral lower limb weakness more on the right side. Laboratory investigations including stool and urine general test results were unremarkable. Magnetic resonance imaging of the brain was performed and showed an intra-axial left parietal mass; a granulomatous lesion was suggested in the differential diagnoses. The patient underwent craniotomy and total resection of the lesion. Histopathology confirmed the presence of active cerebral Schistosoma mansoni infection. Orally administered praziquantel was initiated at a dose of 20 mg/kg twice a day for a total of 3 days along with oral administration of corticosteroids for 2 weeks. The patient improved postoperatively without residual weakness and with no further convulsions.
CONCLUSIONS: Cerebral schistosomiasis is a rare but important consideration in the list of differential diagnoses of cerebral space-occupying lesions. This is of particular importance in in endemic areas like Sudan. In order to reach a diagnosis, careful social and occupational history need to be obtained and correlated with the clinical, laboratory, and radiological findings. Surgical resection along with the use of proper antiparasitic agents usually provides the best clinical outcomes.
摘要：
背景：血吸虫病是一种寄生虫感染，通常影响胃肠道和泌尿生殖道。脑型血吸虫病很罕见,文献中很少报道手术病例。由于病变与许多其他脑部疾病的相似性，诊断通常具有挑战性。治疗通常需要手术切除结合使用抗寄生虫药，这通常会导致良好的结果和良好的预后。
方法：24岁，以前健康的非洲裔男子出现在我们的神经外科门诊诊所，抱怨头痛和抽搐。在检查中，他右侧有双侧下肢无力。实验室检查，包括粪便和尿液的一般检查结果均无明显变化。对大脑进行了磁共振成像，显示轴内左侧顶骨肿块；鉴别诊断中提示肉芽肿性病变。患者接受了开颅手术并完全切除了病变。组织病理学证实存在活动性曼氏血吸虫感染。以20mg/kg的剂量每天两次开始口服给予吡喹酮，共3天，同时口服皮质类固醇2周。患者术后好转，无残余无力，无进一步惊厥。
结论：在脑占位性病变的鉴别诊断中，脑血吸虫病是一个罕见但重要的考虑因素。这在苏丹等流行地区尤为重要。为了得到诊断，需要获得仔细的社会和职业史，并与临床相关，实验室,和放射学发现。手术切除以及使用适当的抗寄生虫药通常提供最佳的临床结果。
方法：24岁，以前健康的非洲裔男子出现在我们的神经外科门诊诊所，抱怨头痛和抽搐。在检查中，他右侧有双侧下肢无力。实验室检查，包括粪便和尿液的一般检查结果均无明显变化。对大脑进行了磁共振成像，显示轴内左侧顶骨肿块；鉴别诊断中提示肉芽肿性病变。患者接受了开颅手术并完全切除了病变。组织病理学证实存在活动性曼氏血吸虫感染。以20mg/kg的剂量每天两次开始口服给予吡喹酮，共3天，同时口服皮质类固醇2周。患者术后好转，无残余无力，无进一步惊厥。
结论：在脑占位性病变的鉴别诊断中，脑血吸虫病是一个罕见但重要的考虑因素。这在苏丹等流行地区尤为重要。为了得到诊断，需要获得仔细的社会和职业史，并与临床相关，实验室,和放射学发现。手术切除以及使用适当的抗寄生虫药通常提供最佳的临床结果。
