Multiple Cerebral Hydatid Cysts Research Articles

Surgical Planning for the Treatment of a Patient with Multiple, Secondary, Intracranial Echinococcal Cysts.

A 27-year-old man with a 2-year history of recurrent hospitalizations for various neurologic and cardiologic emergencies was admitted to our hospital presenting with left hemiparesis, which gradually progressed to quadriparesis, bilateral hemianopsia, intracranial hypertension syndrome, and seizures. A diagnosis of echinococcosis was made, based on the radiologic findings of multiple cerebral hydatid cysts and a sizable cyst of the heart. The hydatid cyst of the heart was treated first with a thoracotomy, and after a month he underwent three consecutive surgical operations for the removal of six cerebral cysts. The patient was on albendazole treatment throughout the entire hospitalization, and this led to the shrinkage and finally to the disappearance of two other cerebral cysts. The patient's focal neurologic signs eventually disappeared, with the exception of a slight unilateral hemianopsia. Ten years after his discharge, he remains in a good condition, with no signs of clinical or radiologic relapse.

Multiple recurrent cerebral hydatidosis: A case report with review of literature

Echinococcisis is an emerging zoonotic parasitic disease worldwide and is a significant health burden among developing nations. Cystic hydatidosis is more commonly found in lungs and liver but rarely cerebral involvement can occur. Multiple hydatid cysts of brain are uncommon and may be wither primary or secondary. Hydatid cyst shoud be considered as a differential diagnosis for cystic lesions of the brain. Here we are reporting a 8 year old boy with multiple cerebral hydatid cysts recurring within three months after surgical rupture of a primary large cerebral hydatid cyst.Asian Journal of Medical Sciences Vol.7(1) 2015 105-107

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

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.

Primary multiple cerebral hydatid disease: still symptomatic despite pathologically confirmed death of the cyst

Hydatid disease is a life-threatening parasitic infestation caused by Echinococcus granulosus. Infection with E. granulosus typically results in the formation of hydatid cysts in liver, lungs, kidney and spleen. Majority of the intracranial cysts are secondary and solitary. Multiple primary cerebral cysts are uncommon. Surgical and medical management of a 14-year-old boy with multiple primary hydatid cysts are presented. 14 cysts, which were symptomatic due to their mass effect, were surgically removed, whereas a deep-seated asymptomatic cyst was followed-up with medical treatment. Despite proper antibiotic regimen the patient was admitted with epileptic seizures six months later. The deep-seated lesion was also surgically removed. Intraoperative observations and pathological examination demonstrated different characteristics, with pericystic gliosis, gel-like cyst content and death scolices within the cavity. In addition to the fact, that the presented case is an additional example for the rare primary multiple cerebral hydatid cysts, to our knowledge it is the first case of a dead cerebral hydatid cyst, causing symptoms despite effective medical treatment.

Differential diagnosis of frontal lobe dilated perivascular spaces

We read with great interest the article by Cerase et al. [1] on the regression of dilated perivascular spaces (DPVS) of the brain. They reported that the most common location of such spaces is along lenticulostriate arteries and that their differential diagnosis includes an extensive list of diseases such as lacunar infarctions, fungal and parasitic infections, and cystic neoplasms [1]. They successfully noted that some cases reported as ‘‘cysts’’ might have been DPVS [1]. We agree and we would like to comment on the differential diagnosis of such spaces, based on a case from our experience where DPVS appeared as cysts within the frontal lobe. Carrying out a neuroanatomical study in our Department, we found (in a coronally sectioned middle-aged male brain) a cystic cavity placed into the lateral putamen (Fig. 1) and a few small cysts in the white matter above the striatum. The cavity, full of a transparent fluid, appeared as an oval hole with a 9 mm diameter. The putamen around the cavity appeared discoloured, probably because of the space-occupying effect of the cystic lesion. This discolouration extended medially to the internal capsule. Other cysts appeared in the white matter above the striatum. Inside the inferior part of the larger cavity there was a diaphragm forming a vesicle. Maximum dimensions of the main lateral putamen lesion were 15 9 14 9 8 mm. All the observed cysts appeared in the left middle cerebral artery territory. Micropathological examination confirmed the DPVS diagnosis. Cysts are common findings at brain imaging [4]. The commonest causes include vascular diseases, infections and tumours [2–5]. Neurocysticercosis occurs in 75% of all cases of systemic cysticercosis [4] and is the commonest worldwide parasitic brain infection. It causes mainly parenchymal cysts with transparent liquid [2]. Cysts may be multiple but do not typically occur in clusters [4]. Toxoplasmosis forms multiple brain abscesses especially in basal ganglia [2]. Echinococcus granulosus forms hydatid cysts in several organs involving the brain [2, 4]. Primary multiple cerebral hydatid cysts are extremely rare, often found in the middle cerebral artery territory. Typically large cysts may contain daughter cysts [4]. Fungal infections, especially in patients with immunodeficiency [5], include cerebral cryptococcosis and aspergillosis. Lowgrade astrocytomas are frequently seen in the frontal lobe and can be located in basal ganglia, oft containing cysts with smooth internal surface and transparent liquid [3]. Metastatic carcinomas are a usual cause for intracerebral cystic lesions, although having a much lower incidence of associated cysts compared to gliomas [2]. There are also neoplasm-associated benign peritumoral cysts, true arachnoid cysts [4], lacunes (usually located in basal ganglia [5]) and beneign congenital neuroglial (glioependymal) cysts, typically located within the frontal lobe [4]. To conclude, there are numerous causes of multiple intracerebral cystic lesions involving both the basal ganglia and frontal lobe white matter and have to be differentiated from DPVS. A location-based approach to intracranial cysts is helpful in establishing an appropriate differential diagnosis [4]. Lesions following a vessel territory could be due to either vascular or infectious disease [4].

Multiple cerebral hydatid cysts

Contrast enhanced CT (Figures 1 to4) showed multiple well-defined bilat-eral, rounded, cystic lesions in the supra-tentorial neuroparenchyma. One of thelesions showed daughter cysts (Figure2). There was no perilesional edema. Oninjection of contrast, the lesions did notshow significant enhancement. In addi-tion to these lesions, there was cerebraledema. With these findings, a diagnosisof multiple cerebral hydatid cysts wassuggested. Abdominal sonography didnot reveal any cysts in other organs. Thepatient did not improve with conserva-tive management and surgery was per-formed. The accessible cystic masseswere removed and were confirmed to behydatid cysts upon histologic examina-tion. The patient improved with addeddrug treatment.

Multiple infected cerebral hydatid cysts

We report an unusual patient with multiple infected cerebral hydatid cysts. A 20-year-old man presented with a 2-month history of headache and progressive left-sided hempiparesis. A cerebral CT scan showed a large and heterogeneous parieto-occipital lesion. During surgery an infected hydatid cyst was discovered with multiple daughter vesicles. Post-operatively the patient was treated with albendazol, cefotaxime and metronidazole. The clinical course was good with total recovery of the hemiparesis. A follow-up CT scan showed persistence of some small deep-seated cysts. Multiple infected cerebral hydatid cyst is uncommon and can be confused with other cystic brain lesions. The aim of surgery is to remove the cyst unruptured and this should be followed by antihelminthic and antibiotic treatment in order to avoid recurrences.

Multiple cerebral hydatid cysts: Report of a case with 24 pieces

A case of 19 years old female patient with 24 large primary cerebral hydatid cysts, in different localisations is presented. Cysts were removed unruptured by five separate operations in 6 months. The patient was observed to be in good health 1 year after the last operation. This case is the first case presented that contains such high number of cysts to our knowledge. The importance of MRI examination in localizing the cysts and designing the operative plan is emphasized. Interestingly, albendazole, which is an antiparasitic drug, was reported to be ineffective by infectious disease department of our hospital, because of large diameter of the cysts, in this case.

Multiple Cerebral Hydatid Cysts Secondary to Embolization From Intracardiac Hydatidosis

We report a rare case of multiple intracranial hydatid cysts secondary to the embolism of cardiac echinococcosis in a 17-year-old girl. The patient presented with stroke and cardiac hydatidosis was found by echocardiography and was treated surgically. Chemotherapy by albendazole was not effective an

Co-occurrence of Cardiac and Cerebral Hydatid Cysts: A Case Report

Cardiac and cerebral hydatid cysts are rarely encountered. In this case, we report a male patient admitted to our hospital with hemiparesis, headache and dysphasia which occurred as a result of complications of both 3,1x3,5 cm single hydatid cyst in the left cardiac ventricle and multiple cerebral hydatid cysts (approximately 18 particles, the largest being 3× 2,2cm). He had undergone surgery 17 month earlier due to a multiple brain hydatid cysts. Although he had been treated with albendazole, multiple cerebral hydatid cysts re-appeared 17 months after operation. This was a rare case in which left ventricular intracavitary hydatid cyst occurred together with brain multiple cysts at the same time. Physicians should be alert about the probability of cardiac involvement when a cerebral hydatid cyst is diagnosed and appropriate investigations should always be conducted.

Multiple primary cerebral hydatid cysts: case report

The authors report the case of a patient with primary multiple cerebral hydatid cysts emphasizing the role played by MRI in planning the surgical approach. The indications for medical treatment of such lesions are also discussed.

Primary multiple cerebral hydatid cysts

Primary multiple cerebral hydatid cysts are extremely rare: In this paper, an 8-year-old male patient who has one primary cerebral hydatid cyst in each cerebral hemisphere is presented. CT findings and operation are discussed. The literature is reviewed and the incidence of multiple cerebral hydatid cyst is compared with the published reports.

Albendazole treatment of multiple cerebral hydatid cysts: case report

A patient with primary multiple cerebral hydatid cysts was treated with albendazole. The daily dose was 10 mg/kg, taken 3 times a day with main meals, in 4 one-month courses separated by intervals of 15 days. Computerized tomography did not reveal any cerebral cysts at the end of therapy; complete calcification was observed at the sites of previous cysts 12 months later. Albendazole was very well tolerated. The results of therapy suggest that albendazole is a valuable contribution to the treatment of cerebral hydatid cysts.