RESUMEN
BACKGROUND AND PURPOSE: Spinal cord involvement is a rare manifestation of schistosomiasis. We describe the MR imaging findings of spinal cord schistosomiasis in correlation with surgery and pathology. METHODS: We report eight cases of spinal cord schistosomiasis. All patients were men (mean age, 16.7 years) with neurologic manifestations who had been referred for spinal MR imaging. In all cases, spinal masses were surgically removed. MR imaging findings were correlated with surgery and pathology. RESULTS: MR imaging showed moderate expansion of the distal spinal cord in all cases. Abnormalities were isointense to cord in T1 and patchy hyperintense in T2-weighted spin-echo images (n = 8). Three forms of contrast enhancement were recognized: (1) intramedullary nodular (n = 8); (2) peripheral (n = 8); and (3) linear radicular (n = 4). Total gross surgical removal of masses by using the Cavitron ultrasonic surgical aspirator was possible in six cases. Diagnosis was established by identification of ova in histopathologic studies: Schistosoma mansoni (n = 3), S. hematobium (n = 1), and uncertain species (n = 4). Intramedullary nodular enhancement was correlated to multiple schistosomiasis microtubercles. Peripheral enhancing lesions correlated to thickened leptomeninges infested by chronic granulomatous inflammatory cells and schistosoma eggs. Linear radicular enhancement correlated with thickened resected nervous roots infested by granulomatous cells and schistosoma eggs. CONCLUSION: Multinodular intramedullary contrast enhancement of the distal cord enabled correct presumptive preoperative MR imaging diagnosis of spinal schistosomiasis in three cases. Accurate diagnosis, through recognition of its MR imaging appearance, allows early treatment and better prognosis of spinal cord schistosomiasis.
Asunto(s)
Imagen por Resonancia Magnética , Neuroesquistosomiasis/diagnóstico , Schistosoma haematobium , Schistosoma mansoni , Enfermedades de la Médula Espinal/diagnóstico , Adolescente , Adulto , Animales , Niño , Estudios de Seguimiento , Humanos , Masculino , Neuroesquistosomiasis/patología , Neuroesquistosomiasis/cirugía , Médula Espinal/patología , Enfermedades de la Médula Espinal/patología , Enfermedades de la Médula Espinal/cirugía , Succión/instrumentación , Resultado del Tratamiento , Terapia por Ultrasonido/instrumentaciónRESUMEN
AIMS: To investigate the efficacy of the anterior repositioning splint and the canine-protected splint in relieving the signs and symptoms of anterior disc displacement with reduction, and to evaluate the effects of both splints on disc position using a standardized magnetic resonance imaging measurement technique. MATERIAL AND METHODS: A sample of 18 adult subjects was studied. The joint disorder was dually diagnosed via pretreatment clinical examination and magnetic resonance imaging. The sample was randomly divided into two groups. In the first group, each subject received an anterior repositioning splint; in the second group, each subject received a canine-protected splint. The treatment lasted 3 months. A standardized magnetic resonance imaging 10-step procedure was developed. Posttreatment clinical examinations and magnetic resonance imagings were done. Pretreatment and posttreatment records were statistically compared. RESULTS AND CONCLUSIONS: Both types of splints were effective in eliminating pain and clicking. All magnetic resonance imaging measurements showed that the canine-protected splint was superior to the anterior repositioning splint, as it allowed the articular disc to resume its normal length and shape while moving in a posterior direction toward recapture. Disc recapture was demonstrated via magnetic resonance imaging in 25% of the subjects from the anterior repositioning splint group, in 40% of the subjects from the canine-protected splint group, and in 33.3% of the subjects from both groups. Thus, noninvasive treatment techniques (such as occlusal splint therapy) might be the treatment of choice for anterior disc displacement with reduction.