Cerebral schistosomiasis

Introduction to cerebral schistosis Cerebral schistosomiasis is a kind of cerebral parasitic disease caused by schistosomiasis eggs deposited in brain tissue through blood circulation. It is endemic in Japan as schistosomiasis. The number of patients with cerebral schistosomiasis is about 1.74 to 4.29% of the total number of schistosomiasis patients. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: epilepsy, coma, hemiplegia

Causes of cerebral schistosomiasis

The adult schistosomiasis is parasitic in the portal vein system and other blood vessels. The eggs produced can be invaded by the systemic circulation. The intracranial sinus or vertebral venous system invades the intracranial or spinal canal. The eggs are deposited in the brain or spinal cord, which can cause:

1 specific inflammatory lesions, mainly in the pial area of the lesion area and the cortex and white matter under it, can be expressed as egg granuloma, pseudotuberculous nodules and scar nodules, and there is plasma cell infiltration, lesions The surrounding capillary network is formed.

2 non-specific lesions, manifested as gliosis, brain (or spinal cord) softening or edema, small vascular inflammatory changes.

Cerebral schistosomiasis prevention

First, control the source of infection

1. The census and general treatment of patients with schistosomiasis on the basis of census, universal treatment, can promptly treat patients to protect the labor force, and can quickly control the source of infection, combined with the effect of prevention and treatment, the prevalence of schistosomiasis in China District, through years of unremitting prevention and treatment, patients have significantly reduced, some areas have eliminated schistosomiasis, the infection rate in the entire epidemic area has generally declined, the census is mainly to take a comprehensive approach to disease investigation, according to medical history, intradermal test, physical examination, ring Egg precipitation test, egg hatching, rectal mucosa biopsy, etc. to make comprehensive judgments, determine the need to treat patients, in recent years in the epidemic area for general census, it is of great significance for prevention and treatment, in the implementation of the establishment of census and patient card And detailed registration, correct statistics and observation of the disease's growth and decline.

2. Census, general treatment of cattle disease is another important measure to control the source of infection, and is of great significance for the development of animal husbandry. Based on the census, the treatment target, the treatment of diseased cattle with nitric amide Intravenous injection with 2% aqueous suspension at a dose of 1.5 mg/kg body weight for buffalo, 2 mg/kg for yellow cattle, and a cure rate of 98% or more for one time.

Second, cut off the route of transmission

1. Checking snails, snails and snails are the key to cutting off the transmission route. The snails should be combined with the basic construction of farmland to build water conservancy, completely change the environment of snail snails and raw cloth, and use physical methods and chemical drugs to eliminate snails according to local conditions.

2. Manure management prevents human and animal feces from polluting water sources, strictly indiscriminate treatment, and strictly implements the manure management system.

3. Water source management protects water sources, improves water use, and makes harmless treatment of drinking water.

Third, protect the susceptible population

Do not touch the infected water, do not walk barefoot in the grassland after the rain and in the morning, harvest in the lake area, fishing, combat training must be in contact with the infected water, you should do a good personal protective measures, conditions permit, you can wear tung oil shoes, long Rubber shoes, plastic protective pants, etc., can also be impregnated with 1% chlorhexidine sulphate alkaline solution, neutralized with dilute hydrochloric acid, the protective effect can be maintained for more than 10 years, the protective agent is applied with anti-scratch and has good effect, and it is in contact with infected water. The former skin is rubbed with 15% butyl phthalate. The original solution can be applied for 8 hours and can be maintained for 8 hours. The emulsion is applied once, the protective effect is maintained for 4 hours, and it is made with 2% chlorsulfuramide fatty acid. The anti-mite pen (made of 2% chlorhexidine and 10% turpentine) has a powerful killing effect on the skin, and the protective effect lasts for more than 10 hours.

Cerebral schistosomiasis complications Complications, epilepsy, coma, hemiplegia

Status epilepticus is a common complication. Due to the deposition of eggs in the brain, it is seen in patients with severe infection or incomplete treatment in the acute phase.

Clinical manifestations include convulsions, headache, and hemiplegia. The eggs in the brain tissue can be directly derived from the adult parasitic in the intracranial sinus, and the eggs can also be transported by the systemic circulation. In general, eggs are deposited under the cortex and cortex to form granuloma. Such small nodules can be scattered, causing meningitis, or they can be piled up to form large granulomas and oppress brain tissue. Clinically, it is divided into epilepsy type, brain tumor type, stroke type and spinal cord type.

1 epilepsy type, the most common, reported 67. 4%, mainly limited to sexual seizures, often accompanied by Todd's palsy after the attack, but also have a strong seizure and sensory seizures.

2 brain tumor type, accounting for 27.2%, caused by large worm granuloma in the brain, such as limb spasm, often accompanied by increased intracranial pressure.

3 stroke type, caused by acute embolization of cerebral blood vessels of schistosomiasis eggs, acute onset, coma, hemiplegia and other symptoms.

4 spinal cord type, occasionally in the spinal canal, rarely formed in the spinal cord schistosomiasis ovarian granulation compression spinal cord, clinically often misdiagnosed as a tumor, confirmed by surgery confirmed.

Symptoms of cerebral schistosomiasis Common symptoms Hepatosplenomegaly pseudotuberculosis nodules hemoptysis coma diarrhea high fever ataxia increased intracranial pressure

The disease is more common in male young adults, and central nervous system symptoms can occur weeks to years after infection with schistosomiasis.

First, acute type

The disease occurs several weeks after infection, mainly due to cerebral edema caused by poisoning reaction and allergic reaction, acute encephalitis or encephalomyelitis, sudden high fever, headache, mental abnormality, seizures, paralysis, incontinence and disturbance of consciousness, etc. May be associated with cough, hemoptysis, diarrhea, urticaria, hepatosplenomegaly, cerebrospinal fluid pressure, protein content, white blood cell count increased.

Second, chronic

It is often caused by several years after infection, mainly due to the symptoms caused by the deposition of schistosomiasis eggs in brain tissue. There are three types of clinical common types:

1. Epilepsy type, most chronic patients belong to this type, schistosomiasis eggs are deposited in the cerebral cortex, the most common types of seizures are partial seizures (localized epilepsy) and Jacksonian episodes, followed by Generalized tonic convulsions (large episodes) and partial complex seizures (psychomotor episodes), some patients with this type may be associated with increased intracranial pressure.

2. Cerebrovascular disease type: acute onset, hemiplegia, aphasia, disturbance of consciousness or even coma, may also be accompanied by partial sports seizures, may be caused by cerebral blood vessels caused by schistosomiasis eggs, need to be caused by other causes of cerebrovascular Identification of the disease.

3. Intracranial space-occupying lesions: caused by schistosomiasis egg granuloma and diffuse cerebral edema, slow onset, headache, vomiting, blurred vision, papilledema, hemiplegia, aphasia, ataxia, often accompanied by Sexual exercise seizures, cerebrospinal fluid pressure and protein content increased, cerebrospinal fluid white blood cell counts were normal or slightly increased, eosinophils may be dominant in the classification.

Examination of cerebral schistosomiasis

1. Schistosomiasis eggs were found in cerebrospinal fluid or brain tissue biopsy.

2, serological tests, blood and cerebrospinal fluid eosinophilia.

3, brain CT and magnetic resonance imaging can show the location of the lesion, the number.

Diagnosis and diagnosis of cerebral schistosomiasi

diagnosis

The increase of white blood cells is not obvious. CT examination can be proved as a local brain mass, and some cases are misdiagnosed as brain tumors. The diagnosis of cerebral schistosomiasis has certain difficulties. The diagnosis is mainly based on 1 evidence of schistosomiasis infection; 2 the above-mentioned symptoms and signs of the central nervous system appear after schistosomiasis infection, but disappear after chemotherapy against schistosomiasis. After the cerebrospinal fluid is concentrated, it can be used as a ring egg precipitation test or an ELISA to detect antibodies, such as a positive responder, which helps to confirm the diagnosis.

Differential diagnosis

The clinical and imaging findings of granulomatous cerebral schistosomiasis are often similar to intracranial space-occupying lesions and therefore need to be differentiated from the following lesions.

1 glioma

Enhanced scanning showed nodular, ring-shaped and lace-like enhancement. After 90 s delayed repetitive scanning, the lesion enhancement gradually decreased and subsided, which was caused by abundant blood supply to the tumor blood vessels. The lesions were mostly located in the deep white matter of the brain, and the occupancy effect was obvious. Serum Immunological tests are negative and help to identify.

2 metastases

Most of the lesions are located in the subcortical region, which may be single or multiple nodules, annular or irregular enhancement, and there may be necrotic cystic changes in the center. There is no tendency to fusion, and the effect of occupying is obvious. There is a history of primary tumor in the clinic, and the brain. Schistosomiasis granuloma is a cluster of multiple intensive nodules, partially fused into a mass, surrounded by uneven patchy enhancement, easier to identify.

3 tuberculoma

Can occur in any part of the brain parenchyma, caused by the deposition of Mycobacterium tuberculosis in the brain, prone to calcification, often multiple thick-walled ring or nodular enhancement, multiple aggregation, tuberculous granuloma with fusion tendency beaded Or plum-like enhancement, visible "microcirculation sign" and "target sign", focal edema is lighter, with tuberculous meningitis with basal pool enhancement and degree of hydrocephalus [27], clinical history of extracranial tuberculosis and Symptoms of tuberculosis and negative serum immunological tests.

4 cerebral cysticercosis

The same is a parasitic disease in the brain, often multi-scattered small vesicles and small nodules, may be associated with the head section, edema and light weight effect, mainly in the white matter area of the brain, can also occur in the ventricles and arachnoid The lower cavity, and cerebral schistosomiasis granuloma is a multi-aggregate size of different nodules, focal edema is obvious, serum cysticercosis or schistosomiasis immunological test is positive, which is helpful to distinguish.

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