Article Text
Statistics from Altmetric.com
Description
A 32-year-old Iraqi Kurdish woman was brought to A&E after developing recurrent generalised tonic–clonic seizures. During the past 4 years, she underwent two craniectomies in Iran for cerebral hydatid cystic disease. Oral albedazole was prescribed for 3 months only, prior to the first surgical operation. The first operation and its discharging notes, including a histopathological report, revealed that she had a solitary hydatid cyst (of Echinococcus granulosus) of the right parietal hemispheric area. The neurosurgeon used short courses of glucocorticoids before and after both craniectomies. Her brain MRI examination is shown in figures 1 and 2.
Brain involvement occurs in 1–2% of all E granulosus infections. The cysts are usually located supratentorially. Children and young adults are the usual targets. Multiple intracerebral hydatid cysts, whether primary or secondary, are uncommon. In the series of Onal et al,1 4 of their 45 patients with solitary intracranial hydatid cysts developed recurrence after neurosurgical removal; all of them followed intraoperative rupture of a primary solitary supratentorial hydatid cyst.
Krajewski and Stelmasiak2 studied 12 patients with cerebral hydatid cystic disease who underwent brain surgery and they followed up them for 5 years. They found that recurrence of multiple cysts occurred in one case and another patient was reoperated on twice for recurrent cysts after an operation in another centre.
It should be noted that despite all the advances in imaging techniques and therapeutic methods, central nervous system hydatidosis remains difficult to cure and patient outcomes are not satisfactory due to the high incidence of recurrence.3
Learning points
-
Multiple intracerebral hydatid cysts are rare.
-
The formation of multiple cerebral hydatid cysts after neurosurgical removal of a primary solitary cyst reflects an intraoperative rupture of the latter with secondary development of these hydatid cysts.
-
Central nervous system hydatidosis remains difficult to cure and patient outcomes are not satisfactory due to the high incidence of recurrence.
Footnotes
-
Competing interests None.
-
Patient consent Obtained.