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This paper presents the case of a 13-year-old female patient, operated in 2015 for left temporoparietal hydatid cyst and reoperated in 2016 for recurrence of the cerebral hydatid cyst. At admission, his GCS scores were E3V4M5. Neurological examination revealed a hemilatéral motor deficit estimated at 3/5 on right side without sensitive trouble. The CT scan showed a large left temporal cystic formation with an infected appearance associated with 4 cystic formations with calcified walls exerting a mass effect on the adjacent parechyma and the homolateral lateral ventricle responsible for a triventricular hydrocephalus. No primary focus was found in the lungs, liver, or other organs. In this article, we will discuss the management of complications related to hydatid cysts. Cerebral hydatid cyst is a rare condition, affecting mainly children. The diagnosis of cerebral hydatid cyst must be evoked in endemic countries in front of a symptomatology of intra-cranial hypertension.

Introduction Hydatid cyst of the heart provides very rarely because of contractions of the heart natural resistance to the presence of viable cysts. Patients with cardiac hydatid cyst may remain asymptomatic for many years or have minor nonspecific complaints, but it is associated with an increased risk of lethal complications if left undiagnosed and untreated. Post rupture cardiac hydatid there is disseminated echinococcosis in the body. Case presentation We report a healthy 20-year old male, while he was working as a farmer who presented with sudden onset acute right lower limb ischemia caused by ruptured of primary hydatid cyst of the heart which managed as a surgical emergency. Discussion Patients with a cardiac hydatid cyst usually have symptoms after its rupture. Hydatid cyst rupture into left-sided chambers may cause systemic emboli, like in our case which presented with emboli of right common iliac artery and later on the patient had cerebral hydatid. Cardiac hydatid cyst can have two extremes, either remain asymptomatic over long periods or be discovered after serious and even fatal complications. Conclusion Acute limb ischemia should be considered as an extremely a rare cause of rupture cardiac hydatid in an endemic area of echinococcosis also, this case confirms the need for the evaluation of the patient well after ruptured cardiac hydatid for other sites of emboli like brain hydrated as in our patient., Highlights • Cardiac hydatid cyst is rare; rupture cardiac hydatid is lethal. • Complication should be considered in case of ruptured cardiac hydatid, even later on. • Rupture cardiac hydatid lead to disseminated emboli that lodged in any part of the body, leads to serious complications.

This paper presents the case of an 18-year-old woman in the 31st week of pregnancy complaining for 8 months a several episodes of vomiting and headache the neurological examination revealed muscle power was 3/5 on left side. The cerebral MRI revealed an intracranial hydatid cyst. The cyst was surgically removed under general anesthesia and put it on albendazole, the diagnosis has been confirmed by the histopathological examination. The patient gave a healthy baby 1 month later without any incident. No primary focus was found in the lungs, liver, or other organs. Primary cerebral hydatid cyst during pregnancy can be successfully treated by surgical and medical intervention, vomiting in a pregnant woman should be investigated to rule out other differential diagnosis., Highlights • This paper presents an 18-year-old woman in the 31st week of her first pregnancy complaining for 8 months a several episodes of vomiting and headache. The neurological examination revealed muscle power was 3/5 on left side and multiple damage to the cranial nerves. • The MRI revealed an intracranial hydatid cyst. The cyst was surgically removed under general anesthesia; the diagnosis has been confirmed by the histopathological examination. • The prognosis is good if the diagnosis is made quickly, leading to early treatment to avoid neurological sequelae. Prevention is achieved through controlled culling of sheep.

The diagnosis of hydatid cyst should be considered in children with seizure in endemic regions.

In the current study, we reported a successfully managed case of giant cerebral hydatid cyst in a 59-year-old male. Cerebral hydatid disease is a rare manifestation of echinococcosis representing 1% - 2% of all cases with hydatid disease. The mainstay of its treatment is surgical excision of entire intracranial cystic lesion, avoiding intra-operative rupture, which can result in subsequent recurrence or anaphylactic reaction. The surgery can be associated with intraoperative complications (including anaphylaxis, bleeding, neurological deficits, development of subdural effusion, epidural hematoma, and pneumocephalus), especially in the cases where the cyst is infected. All of these complications are of significant concern for the anesthesiologists. Thus, it is of paramount importance for anesthesiologists to consider the intra-operative challenges and possible required actions preoperatively.

Hydatid cysts develop in humans with the transmission of Echinococcus Granulosus or more rarely Echinococcus Multilocularis. The disease develops in the liver 50-75%, and in the lungs 15-35% of the cases. Intracranial hydatid cyst is seen 0.5-3% of the cases. In this case report, we aimed to present the anesthetic approach and possible anaphylactic reaction in a giant primary intracranial hydatid cyst. A five years and eight months old boy (19 kg, 114 cm) was admitted to the emergency room with complaints of a headache, nausea, vomiting, and deviation of the eyes for about 1 month. Fundus examination revealed bilateral disc elevation and severe papillary edema. Cranial magnetic resonance imaging showed a large hydatid cyst in the right parietal lobe. The patient was scheduled for craniotomy by the neurosurgeons. After induction and endotracheal intubation, 1 mg.kg-1 pheniramine hydrogen maleate and 1 mg.kg-1 methylprednisolone were administered as a protective measure against anaphylaxis. The cyst excised by Dowling method, and no rupture observed. The patient, who did not have any perioperative complication, was extubated and followed in the intensive care unit of neurosurgery department. Cerebral hydatid cyst is rare and usually seen in children. This could be explained by the presence of right-to-left shunts. The gold standard in the treatment of cerebral hydatid cysts is surgical removal. In order to prevent recurrence and anaphylactoid reaction, the cyst should be removed without rupturing it. The hemodynamic changes with cyst rupture are seen milder in the patients receiving prophylactic treatment. [Med-Science 2018; 7(2.000): 443-5]

Intracranial hydatid cyst is a rare entity, comprising about 2–3% of all hydatid cysts. Similarly, intracranial hydatid cysts account for 1–2% of all intracranial lesions. Clinical symptoms are generally nonspecific and patients usually present with symptoms of increased intracranial pressure. Cerebral hydatid cysts can be either primary or secondary to systemic hydatid disease. Primary cerebral hydatid cysts are usually solitary, unilocular with an intraparenchymal location. Intraventricular extension of hydatid cysts account for a limited percentage of all cerebral hydatid cysts with limited number of cases reported. Herein, we present the imaging and surgical findings of a primary cerebral hydatid cyst that is located in frontal lobe parenchyma with partial extension into the ventricular system.

Kalpte kist hidatik nadirdir vegenellikle erişkinlerde görülür. Nonspesifik semptom ve klinik bulgularındeğişkenliğine bağlı olarak tanı koymak güç olabilir. Önce beyindeki daha sonrakalpteki kistin aşamalı olarak ameliyat edildiği 12 yaşında bir çocuktagördüğümüz serebral tutulumun da eşlik ettiği interventriküler septum localizekist hidatik olgusunu sunuyoruz., Cardiac hydatid cyst is rare andusually occurs in adults. The diagnosis of cardiac cyst hydatid may bedifficult due to nonspecific symptoms and varying clinical presentations. Here,we present a 12-year-old girl with cardiac (interventricular septum) and cerebralhydatid cyst, who was successfully managed with a staged surgical treating the cerebrumfirst, followed by the heart.

Background Hydatid cysts (HCs) are caused by parasites, the larvae of Echinococcus granulosus. They usually affect the liver and lung, but primary brain involvement is rarely seen. HCs may cause a mass effect in the brain. For this reason, surgical excision must be performed. Complications may rarely occur after surgery. Recognition of complications is of vital importance. Case Description A 45-year-old man presented with complaints of personality disorder and severe, long-standing headache. The patient had no neurologic deficit. However, there were symptoms associated with increased intracranial pressure. Radiologic examination revealed intracranial HCs. Complications did not develop during the operation. Six months following the surgery, the patient came back after experiencing unconsciousness. Control cerebral magnetic resonance imaging showed multiple cerebral cysts. Conclusions Surgical resection should be applied carefully in the treatment of cerebral cysts. Complications may occur later in patients who do not develop complications at the time of operation. For this reason, follow-up of the patients should definitely be done by magnetic resonance imaging.

Hydatid cyst is a common zoonosis, affecting the liver and lungs in the endemic areas. Occasionally it involves the brain. We present a rare case of multicystic cerebral Hydatid cyst present over a long time in an adult patient with some odd radiological features like calcification and discuss the relevant literature. In endemic areas, neurosurgeons must be aware of this entity.Nepal Journal of Neuroscience 12:49-51, 2015

L'hydatidose est une parasitose cosmopolite endémique au Maroc. L'échinococcose cérébrale est rare représentant 1 à 2% de l'ensemble des hydatidoses de l'homme et la localisation auniveau de la fosse postérieure est exceptionnelle. Nous rapportons le cas d'un enfant âgé de 12 ansadmis pour syndrome d'hypertension intracrânienne évoluant depuis trois mois. La tomodensitométrie cérébrale a objectivé une formation kystique de la fosse postérieurene se rehaussant pas après injection du produit de contraste. L'intervention chirurgicale révélait un kyste hydatique. Ce diagnostic aété par la suite confirméparl'examen anatomo-pathologique. Le patient a reçuuntraitement médical à base d'albendazole en postopératoire. L'évolutionétait favorable six mois plus tard.

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

Hydatid disease is a human parasitic infestation caused by the larval stage of Echinococcus Granulosus. The liver and the lungs are the most common locations. Cardiac involvement is rare and accounts for 0.5–2% of all hydatid disease. We report an unusual presentation of cardiac hydatid cyst revealed by ventricular tachycardia in a patient with a history of cerebral hydatid cyst.

Hydatid cyst accounts for 3% to 4% of all intracranial lesions. The initial diagnosis is typically based on clinical suspicion, usually with a patient history of having traveled to a region where it is endemic or living in contact with cattle or dogs, and the diagnosis is confirmed with serological tests and imaging. Emergent surgery for cerebral hydatid cyst without first obtaining magnetic resonance image has also been reported in the literature. Presently described is a case of a 22-year-old patient who presented with symptoms of intracranial pressure and neurological deterioration diagnosed as primary cerebral hydatid cyst, and a review of the literature.

Cerebral hydatid disease is very rare, representing only 2% of all cerebral space occupying lesions even in the countries where the disease is endemic. Echinococcal cysts are usually found in the liver and lungs, but can affect any part of the body. Differential diagnosis of hydatid disease should be considered for every cystic mass in any anatomical location, especially in areas where the disease is endemic. Hydatid disease has a worldwide distribution and causes health problems in endemic countries. Here, we are presenting a case of cerebral hydatid cyst in a 7-year-old female child. The main aim of this case is to highlight the rarity of this location and that hydatid cysts must be considered as differential diagnosis in patients with cystic lesions of brain, especially in endemic areas.

Cerebral localization of hydatid cyst is rare (2%) and primarily affects children. We report the case of a young child 12 years old. Clinical symptoms are marked by high intracranial pressure. The diagnosis was confirmed by a Brain CT scan that revealed a large cystic parenchymal intraparietal, multiloculated, on the right hemisphere, with a thin wall partially calcified, evoking a hydatid cyst measuring (74x48mm) width (75mm) length the extracerebral localization was sought and w not found. Abdominal ultrasonography found a hydatid cyst of the liver. Hydatid serology was positive. Treatment was surgical, with a good outcome.

Hydatid cyst is rarely observed in the brain (0.5–4.5%). The frequency of calcified cyst is less than 1%. We present a case of a 15-year-old girl with a 5-year follow-up for grand mal seizures that became resistant to three-drug therapy. The CT scan revealed a calcified parieto-occipital lesion. MRI disclosed a suggestive detached membrane. At surgery, the cyst wall was calcified with typical hydatid sand contents. Since surgery, seizure control has been achieved with one drug. Calcification of a cerebral hydatid cyst is exceptional. MRI enabled the diagnosis in this patient.

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.

In this study, an extremely rare case of a gigantic cerebral hydatid cyst is presented. A right frontotemporal hydatid cyst was detected by computed tomography and magnetic resonance imag-ing. This lesion was extirpated successfully with intact contents with the aid of a neuronavigation system. The literature is reviewed and possible postoperative complications are discussed with the published reports.

A series of 13 pediatric patients underwent surgery for cerebral hydatid cysts at the Department of Pediatric Neurosurgery between 1993 and 2003. Headache and motor weakness were the main initial signs of these patients. A round cystic lesion was the characteristic appearance on computed tomography of each patient. Different cyst locations such as the liver, kidney or spleen were detected in 5 patients. Surgery using Dowling’s technique was performed in all patients as the main treatment. Intraoperative rupture and cyst recurrence were observed in only 1 patient. Subdural effusion, intraparenchymal air and hemorrhage were the main complications observed after surgery. None of the patients died after surgery. Because of its efficacy combined with excellent results, surgery is currently the method of choice in the treatment of cerebral hydatid cyst in children.

The authors present a case of intracranial hydatid cyst with rare neuro-otological manifestations as central vestibular syndrome and massive neurologic deficit. Computed tomography scan showed clearly the location of the cyst. Surgery was applied to remove the cyst. Albendazole used after surgery to improve patient’s prognosis. No such cases were reported before in Yemen to the best of our knowledge, however, cases of epilepsy are not rare but not well investigated. Vestibular dysfunction associated with intracranial hydatid cyst infection is not reported to date. Conclusion: There is no formal consensus for the medical treatment of hydatid cyst whether intracranial or elsewhere. The aim of treatment is to remove the cyst without causing any damage to the tissues occupied by the cyst or make any spillages to avoid anaphylactic shock or recurrence.

Hydatid disease is a rare parasitic disease caused by the larval stage of Echinococcus granulosus. It is endemic in many areas including the Middle-East and the Mediterranean countries. It mainly affects the liver and the lungs but can rarely affect other organs including the brain (Neurohydatidosis). Intracranial hydatid cysts account for 0.5-3% of all the cases of hydatid disease and contribute to 1-2% of all the intracranial space occupying lesions. We report a case of a 27 year-old female patient who presented with hemiparesis and seizures and was found to have a giant primary intracranial hydatid cyst arising in the right parietal lobe.

Cystic hydatidosis is a rare disease which mainly involves the liver and lungs, and rarely the brain. Cysts may be single or multiple. Usually neurohydatidosis with features of raised intracranial pressure such as headache and nausea vomiting or focal neuro-deficits but rarely as refractory epilepsy. We had a 10 year old boy presenting with refractory epilepsy without any focal localizing neurological signs. Brain imaging revealed a huge cystic structure involving the left side of the brain. A diagnosis of brain hydatid cyst was made and the patient was operated on. A large cyst was successfully delivered without rupture. Antihelminthic medication was started and the patient was discharged with no new seizure episodes during 6 month follow up. Hydatid cysts must not be overlooked as a differential diagnosis in children with cystic brain lesions. Surgery is the standard method of treatment, and it is vital to recover the cyst without rupture to avoid severe complications and recurrence.

Intracranial localization is a rare manifestation of hydatid cyst disease (Echinococcosis). It comprises only 2% of cases of Echinococcosis infection even in endemic areas and is predominantly seen in children. Clinical manifestations resulting from raised intracranial tension are nonspecifi c. Imaging with computed tomography (CT) may suggest the diagnosis preoperatively with reasonable accuracy. Multidetector-row CT (MDCT) with its high resolution multiplanar reformations can demonstrate the relationship of the cyst with adjacent brain structures and thus help in planning surgery. This has a practical utility in places where magnetic resonance imaging is not available. We describe a case of cerebral hydatid cyst in a 13-year-old boy who was diagnosed with MDCT, which helped in planning its surgical removal.

Multiple hydatid cysts of the brain are uncommon and may be either primary or secondary. We report a 12-year-old child with multiple hydatid cysts of the brain occurring 1 year after surgical rupture of a primary large and infected cerebral hydatid cyst. Surgical removal of hydatid cysts was successfully performed. Albendazole (10 mg/kg twice daily for 12 weeks) was administered to the patient in the postoperative stage.

A 26-year-old woman in the 28th week of pregnancy presented with a primary cerebral hydatid cyst manifesting as deteriorating consciousness and weakness in the left arm and leg. Cranial computed tomography revealed an intracranial hydatid cyst. The cyst was surgically removed and albendazole was administered. The patient had a spontaneous vaginal term delivery and no problem was observed in the mother or child. No primary focus was found in the lungs, liver, and other organs. Hydatid cyst is still an important disease. Intracranial hydatid cyst without primary foci in organs such as the liver and lungs is very rare. Primary cerebral hydatid cyst during pregnancy can be successfully treated by surgical and medical intervention.

Objective: Brain is involved in 1-2% of hydatid cyst infections. A cranial location is rare. In this study, we aimed to assess clinical findings, radiological investigations, and treatment modalities of cases with intracranial hydatid cyst. Materials and Method: The present study included 26 patients operated for cerebral hydatid cyst disease between January 1990 and October 2012. Results: Seventeen patients were male and 9 were female. The mean age of the study population was 20.3 years (range 7-50 years). Headache and nausea were the most common clinical symptoms. The lesions were demonstrated by computed tomography (CT) and magnetic resonance imaging (MRI) as large, smooth, thin walled, spherical-shaped, cystic homogenous lesions with the same density as cerebro spinal fluid, which showed no edema or contrast uptake. Two patients were complicated or infected cysts with perifocal edema and contrast uptake. In 20 patients, the cysts were removed completely with Dowlings technique, by rectifying cysts without rupturing. Eleven patients with ruptured cysts during operation, recurrent or systemic hydatid cyst were treated medically. Conclusion: Medical therapy appears effective in hydatid cyst disease. Cerebral hydatid cysts should be excised totally without rupturing them. Preoperative imaging techniques are central to surgical planning. Intracranial hydatid cyst should be remembered when CT or MRI shows a cystic lesion, especially in countries where hydatid cyst is endemic. Objective: Brain is involved in 1-2% of hydatid cyst infections. A cranial location is rare. In this study, we aimed to assess clinical findings, radiological investigations, and treatment modalities of cases with intracranial hydatid cyst. Materials and Method: The present study included 26 patients operated for cerebral hydatid cyst disease between January 1990 and October 2012. Results: Seventeen patients were male and 9 were female. The mean age of the study population was 20.3 years (range 7-50 years). Headache and nausea were the most common clinical symptoms. The lesions were demonstrated by computed tomography (CT) and magnetic resonance imaging (MRI) as large, smooth, thin walled, spherical-shaped, cystic homogenous lesions with the same density as cerebro spinal fluid, which showed no edema or contrast uptake. Two patients were complicated or infected cysts with perifocal edema and contrast uptake. In 20 patients, the cysts were removed completely with Dowlings technique, by rectifying cysts without rupturing. Eleven patients with ruptured cysts during operation, recurrent or systemic hydatid cyst were treated medically. Conclusion: Medical therapy appears effective in hydatid cyst disease. Cerebral hydatid cysts should be excised totally without rupturing them. Preoperative imaging techniques are central to surgical planning. Intracranial hydatid cyst should be remembered when CT or MRI shows a cystic lesion, especially in countries where hydatid cyst is endemic.

A child (8 years old) with a gigantic mass of intracranial hydatid cysts (95x90x75 mm) is presented. The first manifestation was difficulty in walking, which was followed by symptoms of raised intracranial pressure. A craniotomy was performed, and more than 25 hydatid cysts were removed. The literature is reviewed and the incidence of gigantic mass of cerebral hydatid cyst is compared in the published reports.

Hydatid cyst disease is a parasitic illness that is rarely located in the brain. We present a case of a 26-year-old female who complained of headache, nausea, and vomiting. The diagnosis was intracranial hydatid cyst disease and was confirmed with radiological and serological tests. Neurological examination revealed papilloedema and left-sided pyramidal signs. She was operated on using the Dowling-Orlando technique. The cyst was removed without rupture, and therapy was completed with albendazole for a period of four weeks. In this article, we discuss the application of the Dowling-Orlando technique, microsurgery, the Valsalva manoeuvre and the positioning of the patient such that gravity could facilitate surgical removal of a giant cerebral hydatid cyst.

Complications related to cerebral hydatid cyst surgery are not uncommon but require prompt diagnosis and treatment. The aim of this study is to demonstrate the radiological findings that would indicate complications after cerebral hydatid cyst surgery in children and to report our results.The data of 25 pediatric patients who underwent surgery for cerebral hydatid cysts over a 16-year period were analyzed retrospectively. The complications related to surgical technique and cyst location were recorded. Postoperative radiological findings of the patients were documented.Intraoperative cyst rupture occured in three patients. Subdural effusion developed in five patients, porencephalic cyst in four, subdural effusion associated with porencephalic cyst in two, hemorrhage in two, epidural hematoma in one, and pneumocephalus in three patients. Subdural-peritoneal shunt was placed in two patients. Recurrence of cerebral hydatid cyst was observed in only one patient who experienced intraoperative cyst rupture. There was no surgery-related death.The complications following cerebral hydatid cyst surgery in children are various and usually not fatal. When appropriate surgical procedures are planned and carefully applied, the results will be excellent with no mortality.

We report the long-term outcome of surgery for cerebral hydatid cyst in 12 children. In only one child, who had been operated on for cardiac hydatidosis a year earlier, was the brain cyst known to be secondary. Of the 12 children. 10 had a single cyst and 2 had multiple cysts. Five single cysts were removed intact by “hydatid birth,” two cysts—one single and one multiple—were removed after puncture and aspiration of the cyst fluid, and the other five—four single and one multiple—were accidentally ruptured in the course of the operation. One patient died of infection of the residual space. 2 died of intracranial recurrence of the parasite (7 and 22 months later, respectively), and one. the child with secondary cerebral echinococcosis, died 6 years later of systemic echinococcosis. Eight patients who had a mean follow-up of 28 years are still living and enjoy very good health, both general and neurological. This long-term follow-up with such good results confirms the usually primary character of cerebral hydatid disease, at least in children. The combination of patent ductus arteriosus and ingestion of unboiled animals' milk might well explain how primarv cerebral hvdatid disease develops in children.

A very rare case of echinococcus cysts of the heart and brain in a 27ﾝyear-old man who worked as a butcher, lived on a farm, and had a dog before disease onset. The initial manifestation of hydatid disease was anaphylactic shock, the etiology of which remained unknown on initial hospitalization. On rehospitalization, the diagnosis of cardiac hydatidosis was made and the patient underwent surgery. Two years later, reoperation was required for hydatid cyst of the brain and cardiac cyst recurrence. There was no other organ involvement from the disease onset, which is rarely reported. Based on this case, we suggest that echocardiography be performed as a standard method in the diagnosis of anaphylactic reaction of obscure etiology in the areas endemic for hydatidosis, even in the absence of symptoms indicative of cardiac involvement. This especially applies to individuals with occupational or epidemiological exposure to the infection.

Objective: Cerebral Hydatid disease (CHD) is very rare manifestation of echinococcosis, representing only 2% of all celebral space occupying lesion even in the countries where the disease in is endemic. The aim of this paper is to describe the characteristic features of cerebral hydatid disease in computed tomography, magnetic resonance Imaging (MRI) and to report a multiloculated cyst (more than 100 loculi) along with its management. Case Presentation: In this paper we have reported a young boy of 20yrs with primary CHD without associated extracranial lesions with focal neurological deficits and intracranial hypertension. The extracranial investigations were found to be negative. CT and MRI of the patient suggested it to be a multiloculated Hydatid cyst. The patient was managed surgically and more than 100 daughter cysts were recovered, antihelminthic medications were given to the patient was discharged successfully. Conclusion: Multilocular Hydatid cyst is a rare SOL of Brain. When present the patient remains asymptomatic for long followed mostly by symptoms of headache and vomiting. Patients may also present with focal deficit or seizures-Surgery remains the mainstay of treatment with careful evacuation of the cysts alongwith the medications for the causative agent (Echinococcus granulosus or multilocularies). Prevention of the disease should be given utmost emphasis.

Background: 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 the liver, lungs, kidney, and spleen. Primary intracranial hydatid cyst disease is extremely rare. Here, we are reporting an unusual case of Echinococcus, where the only identifiable lesion was a hydatid cyst in the brain without liver or lung involvement. We are also providing a description for the surgical technique used to remove the cyst, highlighting the possible surgical pitfalls. Case Description: The patient is a 13-year-old male with a history of progressive headache for 1 month. Intracranial hydatid cyst was suspected based on computed tomography and magnetic resonance imaging findings. The cyst was delivered without rupture using hydrostatic dissection (Dowling's technique), and pathological analysis confirmed the diagnosis. Postoperatively, the patient showed marked neurological improvement and all signs and symptoms resolved. Conclusion: Intracranial hydatid cyst is very rare. Nevertheless, it should always be considered as a differential diagnosis in cerebral cystic lesions, especially in children. The surgical technique used to remove the cyst appears to be safe. However, several precautions must be applied intraoperatively to avoid the catastrophe of cyst rupture.

Our case is an example of primary hydatid cyst disease with a parietal cystic lesion with well-defined borders in the right parietal lobe on MRI. Definitive treatment is complete removal of the cystic lesion by surgery followed up with medical treatment with Albendazole to avoid recurrence. Since our patient refused surgery, she was given 15mg/kg/day Albendazole. As stated above, our patient is still under clinical follow-up for 12 months by Neurology and Infectious Diseases department. In conclusion, hydatid cyst should be included in the differential diagnosis for cranial cystic masses in patients especially from endemic countries. Keywords: Hydatid cyst, brain, MRI

There are still some unknown aspects of the natural course of echinococcus infestation, especially in the brain. The growth rate of the cysts in brain and in other tissues is matter of some discussion. In this report, a huge primary cerebral hydatid cyst associated with a small liver cyst is presented and a possible relationship between the growth rates and the sizes of the two cysts is discussed. It is shown that the brain hydatid cyst grew faster than liver hydatid cyst by a ratio of 3:1.

Intracranial hydatidosis is more common in children than in adults. The most severe complication is anaphylactic response after direct rupture into the subarachnoid spaces. We report a case of brain hydatid cyst that was accidentally drained into the peritoneal cavity and was not complicated by an anaphylactic response or dissemination. Pediatr Infect Dis J

Cerebral hydatid cysts account for 2% of all intracranial masses. Preoperative diagnosis is important since cyst rupture and spillage may cause an anaphylactic reaction. CT is the primary modality for the diagnosis. Two forms of cerebral hydatid cysts have been reported on the basis of CT appearances: unilocular and multilocular. Demonstration of the cyst wall is important for the diagnosis. MRI is superior to CT for demonstrating the cyst capsule and perifocal oedema. We retrospectively reviewed the CT and MRI findings of 6 surgically proven cases of cerebral hydatid cyst and compared the two modalities on the basis of their demonstration of findings helpful in the diagnosis, such as the capsule and perifocal oedema. In 1 case CT showed the capsule. In 2 cases MRI showed a hypointense capsule around the cyst on T2-weighted images. While CT is the modality of choice, in clinical practice MRI is superior for demonstrating the cyst capsule, which is a helpful finding in the diagnosis and can be used in inconclusive cases.

traumatic, or spontaneous rupture ofan existing primary cyst in the brain[15, 19, 22, 25]. In very rare cases,spontaneous or surgical rupture of acyst located in the left ventricle ofthe heart or in one of the great ves-sels may also cause multiple second-ary hydatid cysts in target organs, in-cluding the neural structures [2, 3,29]. Primary cysts, unlike the sec-ondary type, are generally, but notalways, fertile [1, 7, 18, 27].As no extraneural hydatidosis wasdetected, the reported case can easilybe categorized as a “primary multi-ple cerebral hydatid cyst,” which isdefinitely a very rare entity. A verylimited number of patients have beenreported in this category so far, andmost of them have been in the pedi-atric age group [4, 5, 8, 12, 14, 24,27]. A recent report from IstanbulUniversity Istanbul School of Medi-cine Department of Neurosurgerydeals with the long-term range(8–45 years) follow-up of pediatricintracranial hydatidosis: only 1 pa-tient out of 30 in whom this condi-tion was documented was reported tohave multiple primary intracranialhydatid cysts, for an incidence of3.3% [20]. This 7-year-old boy had afatal outcome after four operations in2 years for removal of more than 18hydatid cysts, including intraventric-ular cysts, either by hydatid birth orby the PAIR (puncture, aspiration, ir-rigation, resection) technique. Hewas the only patient in the serieswho required a ventriculoperitonealshunt as the fifth surgical procedure[20]. Cataltepe et al., in Ankara, intheir review of the Hacettepe series,reported 2 cases of primary multipleintracranial hydatid cysts in a total of120 patients, 76% of whom were un-der 15 years of age. The incidence ofprimary multiple intracranial hydatidcysts in their combined series ofadult and pediatric patients was1.7% [9].Perhaps a more likely pathogene-sis in the case reported by Ozkan etal. is the rupture of a viable primarycyst of the brain following a trivialtrauma, leading to secondary hyda-tid cysts [6, 13, 28]. Even thoughthere is no record of such a sequenceof events in the history, the appear-ance of the cysts “as they are closelygrouped and flattened one againstthe other in a single, large nidus,” asin the case reported by Nurchi et al.,provides strong support for this the-ory [18]. Besides the remarkablesimilarity in radiological character-istics, the numerous hydatid cystsextracted in these two pediatric pa-tients also imply the relevance ofthis scenario. Nurchi et al.’s hypoth-esis was that the multiplicity hadmost probably resulted from a fortu-itous tear of the primary cyst, whichhad a superficial location – verysimilar to that of the cyst in Ozkanet al.’s case, which is didacticallydocumented in axial and sagittal MRimages [18, 23].

Multiple intracranial hydatid cysts are uncommon and usually localized in the supratentorial compartment. We report a case studied by CT and MR of multiple intracranial hydatid cysts scattered in various anatomic sites: supratentorial, infratentorial and also intraventricular.

The CT features of cerebral hydatid cysts are divided into two groups. In the unilocular cases, the cyst is large, spherical in shape with sharply defined borders. One side of the cyst wall is very close to the calvarium. The cyst may calcify and may have septae inside. There is no enhancement with contrast media and also no edema surrounding the cyst. In the second group there are multiple and small multilocular cysts. These cysts are in ovoid or polygonal forms like a bunch of grapes, with perifocal edema. After contrast media administration, there is enhancement in the cyst wall. In one case there were numerous cysts in both hemispheres.

We report an unusual case of cerebral hydatid cyst which was found with CT. Unenhanced CT showed a hyperdense, not calcified, ring surrounding the cyst cavity. This has never been reported before. We propose a possible explanation for such abnormal behaviour.

Six cases of cerebral hydatid disease (CHD) were seen in Kuwait over a period of 8 years. The typical CT appearance of a large well-defined spherical nonenhanced unilocular cyst was seen in four cases. Two unusual but characteristic types of calcification were seen, one in each of the remaining two cases.

Summary In countries where hydatid disease is prevalent, cerebral hydatid cyst may be responsible for as much as 10% of all intracranial expansive processes 1 . These cysts may be localized in various anatomical sites within the calvarium as well as the skull itself 1–4 . The authors present a hydatid cyst that was localized in the proximal third of the aquaduct of Sylvius producing increased intracranial pressure by obliteration of the aquaduct. Preoperative diagnosis was made by computerized tomography and the cyst was removed by a posterior fossa approach.

✓ A rare case of multiple primary hydatid cysts of the brain is reported in a 9-year-old girl. There were five cysts, occupying most of the right supratentorial region. The biggest cyst measured 9 cm across, while the smallest one was 4.5 cm in diameter. The diagnosis was based on computerized tomography findings. The patient did not have any evidence of hydatid disease elsewhere in the body. The delivery of all the cysts resulted in the dramatic neurological recovery of this patient.

✓ Bilateral intracerebral hydatid cysts developed in a 14-year-old patient after an infarct of presumed embolic origin in the left frontotemporoparietal region. The average rate of growth of these cysts was about 5 cm per year. This suggests that the growth rate is far from uniform and indeed, particularly in young patients, may be much faster than originally estimated.

Summary A case of hydatid cyst in the cavernous sinus is reported. The cyst was treated by cyst aspiration and formalin injection

✓ A case of presumed cerebral hydatid embolism in the course of cardiac surgery for echinococciasis is reported. Follow-up computerized tomography immediately after embolization, and 1 and 5 years later suggested an average growth pattern of 1 cm/year for intracranial hydatid cysts in the adult.

✓ The authors report 17 cases of intracranial hydatid cyst out of 500 brain tumors seen in 20 years, and analyze clinical, investigative, diagnostic, and operative findings.