Cerebral Schistosomiasis

An arborizing pattern of contrast enhancement on brain imaging in a patient with focal seizures should raise suspicion for cerebral schistosomiasis. This form of neuroschistosomiasis results from deposition of Schistosoma eggs in the brain, triggering a granulomatous immune response. Cerebral schistosomiasis may present as acute schistosomal encephalopathy or pseudotumoral encephalic schistosomiasis; our patient’s presentation is more consistent with the latter. Diagnosis requires evidence of Schistosoma infection along with compatible neurologic and neuroimaging findings. In this case, stool examination identified S. japonicum, the species most associated with cerebral involvement.