Abstract
BACKGROUND: Cerebral pseudotumoral schistosomiasis is an uncommon and underreported condition, posing significant diagnostic challenges due to its ability to mimic other neurological conditions, especially in patients presenting with persistent seizures and imaging findings indicative of an infectious etiology. CASE DESCRIPTION: We report the case of a 16-year-old male who presented with persistent headaches and recurrent seizures despite adherence to antiseizure medications. Neuroimaging findings suggested an infectious process but were inconclusive in differentiating between a tuberculoma and cerebral schistosomiasis. Given the differing therapeutic approaches required for these conditions, a definitive diagnosis was pursued through a brain tissue biopsy, which confirmed cerebral schistosomiasis. This diagnosis guided appropriate treatment, leading to clinical improvement. CONCLUSION: This case highlights the critical role of biopsy in establishing a definitive diagnosis when imaging results are inconclusive and suggests the importance of exploring the use of adjunct diagnostic methods like magnetic resonance spectroscopy, hence decreasing or potentially eliminating the need for an open biopsy.