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CASE IMAGE
Year : 2022  |  Volume : 2  |  Issue : 4  |  Page : 252-253

Giant Primary Cerebral Hydatid Cyst


Department of Pediatrics, Sri Ramachandra Children's and Dental Hospital, Guntur, Andhra Pradesh, India

Date of Submission08-Sep-2022
Date of Decision27-Oct-2022
Date of Acceptance28-Oct-2022
Date of Web Publication29-Nov-2022

Correspondence Address:
Dr. Lokeswari Balleda
Department of Pediatrics, Sri Ramachandra Children's and Dental Hospital, Guntur, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipcares.ipcares_213_22

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How to cite this article:
Balleda L, Kolla S, Chandrasekhara Reddy T. Giant Primary Cerebral Hydatid Cyst. Indian Pediatr Case Rep 2022;2:252-3

How to cite this URL:
Balleda L, Kolla S, Chandrasekhara Reddy T. Giant Primary Cerebral Hydatid Cyst. Indian Pediatr Case Rep [serial online] 2022 [cited 2023 Jan 30];2:252-3. Available from: http://www.ipcares.org/text.asp?2022/2/4/252/362246

A previously healthy 11-year-old female child presented with a progressively increasing headache for 15 days. There was no history of ataxia, nystagmus, and weakness. There were no visual problems or chronic upper respiratory problems indicative of sinusitis. Examination revealed the absence of hypertension, bradycardia, and abnormal breathing pattern. The Glasgow Coma Scale was 15/15. There were no significant neurological findings apart from the bilateral 6th nerve palsy. The fundus was normal. Systemic examination was normal. A magnetic resonance imaging of the brain was planned considering a structural central nervous system lesion.

The magnetic resonance imaging revealed a large (42 mm × 39 mm × 42 mm), well-defined, cystic lesion in the left frontal lobe, with a regular wall and collapsed intra-luminal membrane. Surrounding white matter edema, mass effect with herniation, and right ventricular dilatation were noted [Figure 1]. The primary radiological differential diagnosis was a cerebral hydatid cyst. Additional investigations like a chest X-ray and abdominal ultrasonogram excluded hydatid cysts elsewhere at other likely sites. The IgG anti-Echinococcus antibody titres were normal. The intact cyst was removed surgically [Figure 1]a and [Figure 1]b and [Figure 2] using the Dowling technique, followed by oral Albendazole as per standard protocol. Histopathology confirmed the diagnosis. The child was discharged uneventfully, is on follow-up and is asymptomatic.
Figure 1: (a and b) Shows Preoperative MRI Brain which shows a large CSF density cystic lesion on the left side causing mass effect and midline shift to the right. Postoperative CT scan showed a large space without any residual matter. MRI: Magnetic resonance imaging, CT: Computed tomography, CSF: Cerebrospinal fluid

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Figure 2: This shows the cyst removed in toto after operation. The cyst appears creamy and smooth

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Hydatid disease is caused by Echinococcosis, the larval stage of a tapeworm Echinococcus granulosus.[1] Humans get infected accidentally through Feco-oral route via direct contact with an infected dog. Four species infect humans with the respective presentations: E. granulosus (cystic echinococcosis), Echinococcus multilocularis (alveolar echinococcosis), Echinococcus oligarthus, and Echinococcus vogelix (polycystic hydatid disease). The most common affected sites are the liver (75%) and lungs (15%) followed by the spleen, kidney, heart, bones, and brain (10%). Brain hydatid cysts can be primary (single) or secondary (multiple). Clinical manifestations are usually due to elevated intracranial pressure and/or mass effect. Focal neurological deficits may occur depending on the location and size. Definitive diagnosis is by detection of IgG anti-Echinococcus antibodies using enzyme-linked immunosorbent assay (though titers are low or absent in isolated cysts), or histopathology. The Dowling Orlando technique is the most effective surgical method for the removal of cerebral hydrated cysts with minimal risk of rupture.[2] In this technique, the head is placed lower than the level of the operation table and the craniotomy flap is opened according to the size and site of the lesion. The surgical field must be cleaned with scolicidal solution (warm 3% normal saline solution) to prevent recurrence because even a minimal spillage can lead to new cysts formation, i.e. 1 mL of cyst fluid contains 4,000,000 scolices. Concurrent high-dose glucocorticoids minimize the inflammatory response. Presurgical administration of benzimidazoles such as Albendazole or Mebendazole reduces the rate of recurrence, and the medication should continue for 6 months.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient's parent has given his consent for images and other clinical information to be reported in the journal. The patient's parent understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Altibi AM, Qarajeh RA, Belsuzarri TA, et al. Primary cerebral echinoccocosis in a child: Case report – Surgical technique, technical pitfalls, and video atlas. Surg Neurol Int 2016;7:S893-8.  Back to cited text no. 1
    
2.
Guzel A, Tatli M, Maciaczyk J, et al. Primary cerebral intraventricular hydatid cyst: A case report and review of the literature. J Child Neurol 2008;23:585-8.  Back to cited text no. 2
    


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