Sarazin and colleagues reported the case of a 25-year-old female with a history of recent travel to Madagascar, presenting with fever for a week, rapidly progressive headache, limb ataxia, and memory impairment. She was diagnosed with watershed bilateral infarction. Stool positivity and seroconversion occurred only 3 weeks after neurological presentation. The case was complicated by progressive cardiomyopathy requiring surgery. No neurological recurrence occurred.
Sonneville and co-workers described a case of a 56-year-old woman with sudden onset of hemiplegia due to watershed infarction. Acute pericarditis and myocarditis complicated the case. The outcome was favorable with steroidal therapy, and neurological recovery was reported after 6 months.
Two case reports were published by Jaureguiberry. A 54-year-old man living in Mali for several years, where he had been repeatedly exposed to fresh groundwater, was medically examined due to a history of fever for 10 days, followed by acute cerebellar syndrome, hemiparesis, and confusion, with multiple cortical and subcortical infarcts caused by cerebral vasculitis. Serology and urinary positivity for the presence of schistosoma eggs was observed 4 months after the acute event when the patient still showed psychomotor slowing and insomnia. The second case reported a 21-year-old male patient who bathed 1 month earlier in a lake in Mali. Four days after starting therapy with praziquantel due to a maculopapular rash and fever, he presented with confusion and anosognosia, and he was diagnosed with cerebral vasculitis. The patient had a positive serology at hospitalization, but schistosoma eggs could be detected in urine only 4 months later. The neurological features resolved after 48 hours of steroid therapy.
In the report by Camuset and coworkers, a 28-year-old female patient went on a mission in Burkina Faso for 1 year, where she bathed in a lake. She had a 6-month history of headaches. She was hospitalized for hemiplegia associated with an unspecified language disorder. Serology and rectal biopsy showed positivity for schistosoma. One month later, the patient presented with headache, diplopia, and VI cranial nerve palsy, with stenosis of carotid syphon. The exacerbation of vasculitis was considered due to the adverse effects of praziquantel. Minor improvement of carotid stenosis was reported at 6 months, but no details on hemiplegia were provided.
The case reported by Wu and colleagues lacked anagraphic details. The patient presented with acute headache and walking impairment, and multiple low densities in the alba were observed on imaging. Exposure history suggested chronic schistosomiasis.
Grandier-Perez and coworkers reported the case of a 19-year-old girl back from Kenya, where she had bathed in lake Victoria 2 weeks earlier. She presented with a 15-day history of fever and urticaria. Neurological features occurred on day 12, with the appearance of ataxia, confusion, and unilateral dysmetria. Imaging showed features of watershed infarction. Serology was positive at hospitalization, while stool and urine became positive for the presence of schistosoma eggs 4 months later. A full neurological recovery was reported 5 days after starting steroidal therapy.
Lastly, in the report by Nyein and colleagues, a 52-year-old patient had visited Myanmar during a schistosomiasis outbreak 1 year earlier, had swum in ponds and had eaten snails, and was hospitalized because of cognitive impairment, memory deficits, and behavioral changes, with multiple cerebral infarcts on imaging. This picture was followed, 3 weeks later, by dysarthria, hemiplegia, and facial palsy, with frontal lesions on imaging, bilateral terminal internal carotid artery narrowing, and beaded anterior cerebral artery. New frontal lesions appeared at week 9 after hospitalization. The patient had a positive serology, but no eggs were detected by optical microscopy assessment of stool. On follow-up, neurologic recovery was partial, and the patient could walk with the aid. The cases are summarized in Table 1; for clarity, each case was assigned with a number, which will be used further in the text to refer to single patients. Tables 2 and 3 reports the incidence of specific neurological symptoms.