A rare case of primary multiple hydatid cysts of the brain in a 10-year-old child

Abstract

Echinococcus is a cestode. The most common Echinococcus species causing human infection are E. granulosus and E. multilocularis [1]. The commonest sites for cysts are the liver (59%–75%), followed in frequency by lung (27%), kidney (3%), bone (1%–4%) and brain (1%–2%). Other sites such as the heart, spleen, pancreas and muscles are very rarely affected [2]. Multi-organ involvement without liver cysts is reported [3]. Brain cysts caused by E. granulosus are rare; they occur during childhood in endemic areas [4]. Cerebral hydatid cysts are usually supratentorial and tend to occur in the middle cerebral artery distribution [5]. The cyst’s predilection for white matter is undisputed, but the exact reason for this is unknown; some believe it is because of the arterial distribution [6]. Cerebral hydatid cysts are solitary. Multiple hydatid cysts in brain parenchyma are very rare and result from spontaneous, traumatic or postsurgical rupture of cysts in the brain or elsewhere; with embolization of hydatid to brain, multiple cysts may arise in the brain itself [5–8]. Cerebral hydatid cysts are classified as primary or secondary. Primary intracranial hydatid cyst results from direct infestation of the brain by the larva without involvement of other organs such as liver and lungs. Primary cysts are fertile, containing brood capsules and scolices, and their rupture may result in recurrent intracranial hydatid cyst. Primary cysts are usually solitary. Primary multiple cerebral hydatid cysts are quite unusual, resulting from multiple larvae infecting the brain after bypassing the liver and lungs [8,9]. Secondary cysts are generally multiple and result from the rupture of hydatid cysts in the brain or in other organs of body. These cysts lack germinal membranes and are infertile, with negligible risk of recurrence after rupture [6,7,10]. Here we report a rare case of primary multiple hydatid cysts of the brain in a 10-year-old child, with a total of 73 cysts removed from his cerebrum and 5-year follow-up. Written informed consent was obtained from the patient’s parents for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Eastern Mediterranean Health Journal’s Editor-In-Chief.