Childhood refractory headache: Alarming sign of hydatid disease in endemic area

Abstract

A 12 years old boy was severe headache, decreased vision and vomiting was evaluated by Brain MRI that showed a cystic space occupying lesion in the left brain hemisphere. Further imaging showed sharply defined round opacities in both lungs in favor of hydatid disease and multiple cystic lesions in the liver. Anti-biotics and anti-helminthic medications were started and hydatid cysts were resected surgically in staged operations. Occasional seizures and serious visual impairment were observed after surgery. The patient has been followed for 3 years. Finally he resumed ordinary activity, seizure is controlled and visual acuity is improved to high myopia. Cerebral hydatid is rare but more commonly seen in children. It may remain asymptomatic for a long time due to the slow growth of the cyst. Primary symptoms may be nonspecific while any neurologic deficit or severe headache and persistent irritability should raise the concerns about hydatid involvement of central nervous system. The symptoms are due to mass effect of the cyst so meticulous eyes’ fundal examination will be helpful. Any Severe retractable headache or lateralized neurological signs among pediatrics in endemic regions must raise the suspicious about hydatid disease and mandats prompt imaging to evaluate multi organ hydatidosis. • Hydatid disease is endemic in rural areas especially in Middle East, South America, Australia, New Zealand, and South Africa. • Hydatid cysts are commonly seen in the liver and lungs while Extra-hepatic hydatidosis is more common in pediatrics. • Retractable headache or lateralized neurological signs among pediatrics mandates further assessments for CNS hydatidosis in endemic area. • Brain involvement is rare and may be remain asymptomatic despite its large size for a long time due to the slow growth of the cyst. • Any Severe retractable headache or lateralized neurological signs among pediatrics must raise the suspicious about central nervous system involvement with hydatid disease in endemic regions.