Background: Schistosomiasis affects more than 200 million people, however its public health importance is often underrated.  Symptomatic  cerebral neuroschistosomiasis  (NS), a severe and rare presentation, accounts for  2-4% of  infected individuals. Early recognition is necessary since an available effective treatment may prevent further neurological deterioration.

Objective: This report aims to provide the readers increase awareness on clinical presentation, proper evaluation, early diagnosis and treatment of cerebral NS and to describe its characteristic MRI appearance.

Case: We present a case of a  12 year old male residing at  Leyte, Philippines with signs of increase intracranial pressure,  visual problems and focal neurologic deficits.  Cranial CT scan considers multicentric glial brain tumor. He was referred to our institution for neurosurgical consult.  Cranial MRI showed two mass lesions (hypointense on T1 and hyperintense on T2) exhibiting a cluster of confluent nodular and linear enhancement with extensive white matter edema.  Blood circumoval precipitin test is positive.  Kato Katz and stool concentration technique are negative for any ova/parasite. Treatment with Praziquantel and Prednisone showed marked  improvement in neurologic deficits and marked reduction in enhancement at repeat MRI done after 2 months of starting the medication.

Conclusion: This case highlights the importance of early recognition and high index of suspicion of cerebral NS in a young patient from an endemic area.    The typical MRI appearance may be useful for diagnosis in endemic regions and  in cases imported into countries in which the disease is not endemic.