Ischaemic Stroke Due to Schistosoma haematobium (Cerebral Neuroschistosomiasis): A Case Report in a Young Man

Schistosomiasis is a major neglected tropical disease; neurological involvement (neuroschistosomiasis) is uncommon, and cerebral disease is classically associated with Schistosoma japonicum, whereas S. haematobium more often causes urinary and spinal disease.Cerebral neuroschistosomiasis presenting as ischaemic stroke in S. haematobium infection is rare.We report a 22-year-old man, originally from Senegal and resident in the United Kingdom, who presented with sudden-onset left-sided weakness, sensory symptoms, dysarthria, poor balance and headache two days after onset (National Institutes of Health Stroke Scale score 5, improving to 3 at 24 hours).MRI confirmed an acute right thalamic infarct with true restricted diffusion, and CT/MRI intracranial angiography demonstrated a multifocal vasculopathy; a comprehensive autoimmune vasculitis screen was negative.Admission bloods showed a peripheral eosinophilia of 1.4 ×10⁹/L (reference 0-0.5 ×10⁹/L).Prompted by haematuria and his prior residence in an endemic area, urine microscopy confirmed S. haematobium ova, serum schistosomal enzyme-linked immunosorbent assay (ELISA) was positive, and cystoscopy showed a characteristic bladder "sandy patch."Expert neuroradiology review felt the MRI and MRA head were in keeping with cerebral neuroschistosomiasis, and a follow-up contrast MRI head and spine showed a nodular enhancing thalamic lesion with perilesional oedema, also in keeping with cerebral neuroschistosomiasis.This lesion had shown some regression prior to commencement of treatment.Following multidisciplinary input, corticosteroid cover was given before praziquantel, with empirical ivermectin to cover Strongyloides; the patient continued to improve clinically, with no further neurological events over 12 months of follow-up.A repeat MRI head and MRA head at six weeks showed stable vasculopathy with maturation of the thalamic infarct.Schistosomiasis should be considered in young patients with stroke from endemic areas, particularly with eosinophilia or a vasculitic angiographic pattern, and corticosteroid cover before praziquantel should be considered when central nervous system involvement is suspected.