[Neuroimaging and efficacy of treatment in advanced African trypanosomiasis]

West African trypanosomiasis (WAT) is rare in Spain. Delay in its diagnosis and treatment leads to irreversible diffuse meningoencephalitis and finally death of the patients.

We described a patient in whom the diagnosis of advance WAT had been delayed. He had headache, alteration of the level of consciousness and sleep pattern, psychiatric disorders, crises, extrapyramidal, sensitive and endocrinological clinical alterations. Biochemical investigation showed slight anemia with marked thrombocytopenia, and raised ESR and IgM. Initially serology was negative for trypanosomes, although examination of the CSF confirmed the diagnosis. MR showed extensive lesions of the basal nuclei, brainstem and white matter. Both the clinical abnormalities and the lesions shown on MR disappeared after treatment with intravenous difluoromethylornithine. The patient is now symptom-free and at work as usual.

Find diagnosis of WAT requires isolation of the parasite from the blood, the bone marrow or CSF. When other complementary tests (such as serology) are negative, the diagnosis should not be ruled out. There are few neuroimaging studies of WAT, and only by CT. We have found no MR studies of patients with WAT, in the literature. We emphasize the close correlation between the clinical and radiological findings in this case, and the excellent result obtained after treatment.