Multiple Cerebral, Calcified and Infected Hydatid Cysts Case Report and Literature Review - Multiple Cerebral, Calcified and Infected Hydatid Cysts Case Report and Literature Review - Open Access Pub

DOI10.14302/issn.2470-5020.jnrt-15-774 The hydatidosis is an endemic illness in regions of the middle Orient, Mediterranean, south of America, North Africa and Australia. The preferential localization of the hydatid cysts is the liver (48%), the lung (36%), and in (4%) of cases it localizes in unaccustomed place as the brain 1, 2. Intracranial localization is a rare condition principally found in childhood. Multiple or calcified hydatid cysts result from spontaneous, traumatic, or surgical rupture of a primary cerebral hydatid cysts, or from multiple larval intake or rupture of a cyst elsewhere with embolisation of the parasite to the brain 1, 2, 3, 4, 8, 9. The coexistent bacterial infection of hydatid cyst in the brain is an extremely rare condition. Only three cases of multiple infected cerebral hydatid cysts are reported in literature, 3, 9, 15. But multiple, calcified and infected hydatid cysts have never been reported. A 27 years-old male patient was admitted with 1 month history of headache, fever, short term memory lack, aphasia, right hemiparesis and seizures. He had liver hydatid cysts excised 8 years before and was treated with adjuvant medication (albendazole). The neurological examination revealed right central third cranial nerve palsy and hemi paresis, with Babinski sign positive, aphasia and papilledema on ocular fundus. The Glasgow Coma Scale was evaluated to 10/15 (E:3; V:1; M:6). A brain CT scan showed a large left temporoparietal intracerebral multiple and calcified hydatid cysts, important mass effect with midline shift about 7 mm following by an obstructive hydrocephalus (Figure 1). Other cysts were found in thalamic region (Figure 2). The Thoraco-abdominal CT scan showed multiple intra peritoneal hydatid cysts (Figure 3). A left temporo parietal craniotomy was performed in emergency. After corticectomy, using Arana-Iniguez technique, the appearance of the capsule suggested infected hydatid cysts with a purulent material which was aspirated. Numerous hydatid cysts were lifted away and several daughter vesicles were carefully removed without rupture (Figure 4). Macroscopically, the abscess wall appeared to be thick, calcified and tightly attached to lateral ventricular, so it could not be removed. The deep cyst overlying the third ventricle was left.in place. Microscopic examination demonstrated live scoleces, protoscoleces and multiple hooks. These findings are consistent with hydatid cyst (granulosis ecchinococcus) (Figure 5). Bacteriology examination found several white blood cells in the pus (neutrophilia) and infection by