Primary multiple cerebral hydatid disease in a young patient with surgically-treated intracerebral haemorrhage

Abstract

Introduction: Cerebral hydatid disease (CHD) is rare and the multiple-cystic variety is even rarer. In this paper, we report a case of multiple CHD and explore a possible link with a preceding spontaneous intracerebral haemorrhage (ICH). 
 Case presentation: A 27-year old gentleman with a history of surgically-evacuated, spontaneous ICH presented with severe headache, left-sided weakness - Medical Research Council (MRC) grade II - and recurrent tonic-clonic seizures, while on a full dose of anti-epileptic medication. Brain magnetic resonance imaging (MRI) scans showed multiple intra-axial cystic lesions in the right hemisphere. The cysts were removed intact using Dowling’s technique through a large temporoparietal craniotomy. The surgery went uneventful and the patient recovered as expected. Post-operatively, a prophylactic course of albendazole (200 mg) was prescribed. On his one-year follow-up visit, the patient was symptom-free and his weakness had improved (left upper limb: MRC grade IV and full power of the left lower limb). The computed tomography (CT) scan showed no new findings. 
 Conclusion: Primary cerebral hydatid disease is rare and the multiple-cyst variety is even rare. In this case, a peculiar association with a surgically-treated ICH was explored with possible theories to suggest future research directions.