Cauda equina and conus medullaris syndromes due to Spinal Cord Schistosomiasis: a case report

Context: Schistosomiasis is a prevalent disease in Brazil whose medullary form can be a serious and disabling condition. Diagnosis is clinical and laboratorial, based on neurological symptoms besides Schistosoma infection exams. Spinal Cord Schistosomiasis (SCS) can be associated with cauda equina syndrome (CES) adding “saddle” anesthesia and low back pain as symptoms. Case Report: A 22- year-old male presenting progressive bilateral and proximal pelvic weakness associated with urinary and fecal incontinence besides mild low back pain during 4 months. Patient reports daily swimming practice in rivers. Neurological examination revealed grade 3 weakness of the proximal muscles, patellar hyporeflexia, saddle anesthesia and hypotonia of the proximal muscles. Magnetic resonance imaging of the lumbar spine showed conus medullaris fusiform enlargement, associated with T2 and STIR hyperintensity (edema), hyposignal in T1, findings suggestive of an inflammatory / infectious etiology. Laboratory tests revealed a complete blood count with mild leukocytosis and eosinophilia; positive IgG serology for schistosomiasis; increased protein levels in the cerebrospinal fluid; stool analysis was normal. The diagnosis of CES and conus medullaris syndrome due to SCS was established and treatment with prednisone and praziquantel was initiated, with significant improvement in clinical symptoms. Conclusion: This case emphasizes the importance of early diagnosis and the initiation of appropriate therapy in order to prevent irreversible injuries in cases of CES and conus medullaris syndrome, both conditions of high morbidity that are often overlooked.