We provide a comprehensive overview of the current evidence on the occurrence, clinical characteristics, diagnosis, and management of spinal cord schistosomiasis.

Neuroschistosomiasis is the infection of the central nervous system by the blood fluke of the genus Schistosoma. Although it is uncommon compared to other forms, it can cause severe complications. Spinal neuroschistosomiasis is a major concern in endemic areas especially when concurred with delayed diagnosis. 

We used a systematic approach to search in PubMed, Web of Science, and Scopus until November 2024 for reports on spinal neuroschistosomiasis. The reports were screened by two authors independently and any conflicts were resolved by a third author. We extracted data on patient demographics (age and gender), endemicity, clinical forms, radiological and laboratory assessment, and management.

A total of 109 reports with 230 patients were included. The mean patients’ age was 25.22 ± 14.65 years, with 183 (79.6%) males and 47 (20.4%) females. The infection was reported to occur in endemic areas in 197 (85.7%) cases, and the majority was due to S. mansoni in 131 (57%) cases. The clinical forms were 111 (48.3%) myelitic, 77 (33.5%) myeloradicular, and only 12 (5%) granulomatous. The dorsal cord was involved in 130 (56.5%) cases while the conus medullaris was involved in only 40 (17.4%) cases. The brain was involved concomitantly in four cases. While most cases followed a presumptive diagnosis, only 74 cases were reported to have a histopathology examination of the spinal lesions. Praziquantel and prednisone/prednisolone were prescribed in 172 (74.8%) and 123 (53.5%) cases respectively. The majority of cases showed partial to complete recovery.

Spinal schistosomiasis can have a severe course on delayed diagnosis and management. Physicians should consider such in patients from endemic areas or history of traveling and not delay the antiparasitic and steroid initiation.