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Acta Neurochir (Wien) (1998) 140: 833±834 Acta Neurochirurgica> Springer-Verlag 1998 Secondary Multiple Intracranial Hydatid Cysts Caused by Intracerebral Embolism H. C. UgÆur, A. Attar, C. BagÆdatogÆlu, A ErdogÆan, and N. Egemen Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey days an immediate operation was decided on. A large right frontal craniotomy was performed. 5 cysts localised in the right Sylvian Hydatid cyst is an infestation in humans caused by ®ssure especially in the right frontal and parietal region were ex- the larval stage of the cestode species Echinococcosus posed. The cysts were delivered one by one. It was possible to sepa- rate the deep surfaces of the cysts from the parenchyma by irrigating granulosus or Echinococcosus multilocularis (alveo- the cleavage plane with physiological saline. After the ®rst operation laris). Dogs are the de®nitive hosts, and the inter- the patient's neurological status dramatically improved. After one mediate hosts are sheep and man. Primary hydatid month the second operation, bilateral parieto-occipital craniotomy, cysts of the brain are always solitary, have brood cap- was performed and the 2 cysts 3 Â 3 and 4 Â 4 cm in size were deliv- ered successfully without rupturing (Fig. 2). There was no neuro- sule and scobies. Secondary hydatid cysts of the brain logical deterioration after the second operation. The patient was result from spontaneous, traumatic or surgical rupture transferred to cardiovascular surgery for the removal of the cardiac of a primary solitary hydatid cyst or as a consequence of a cyst rupture elsewhere and embolization of hyda- tids to the brain, as in our case. These cysts are sec-ondary, lack a brood capsule and are infertile [6]. Be- cause contractions of the heart provide a naturalresistance to the presence of viable hydatid cysts, pri- mary echinococcosis of the heart is seen very rarely, however the left ventricle is the most common site ofcyst formation [5].
An 18-year-old woman was admitted to our clinic with a 3-month history of headache, nausea and vomiting. Her complaint increased in the past ten days and she developed mild left hemiparesis. Neuro- logical examination revealed bilateral papilloedema, and mild left hemiparesis. Thorax and abdomen were screened by radiological imaging methods and a hydatid cyst was observed in the intra- ventriculer septum of the heart (Fig. 1). Computerised brain tomog- raphy showed multiple hydatid cysts occupying right frontal, right parietal, right parieto-occipital, and left parieto-occipital region (Fig. 2). The Antiparasitic drug (albendazol) was administered.
Fig. 1. CT scan showing a hydatid cyst in the interventriculer Because of the rapidly increasing neurological de®cit in the past ten H. C. UgÆur et al.: Secondary Multiple Hydatid Cysts Caused by Cardiac Echinococcosis Fig. 2. CT scan demonstrating multiple hydatid cysts before operation the cysts. The recommended surgical procedure is cyst Cerebral hydatid cysts occur in 1 to 2% of all Echi- removal without rupture via the hydatid birth tech- nococcosis granulosus infections. Intracranial hydatid nique [1, 2, 3]. In our case, seven cysts were delivered cysts, 10±15% of which are multiple hydatid cysts, without one rupturing. In patients with secondary constitute 1.6 to 5.2% of all intracranial space occu- multiple intracranial hydatidosis caused by intra- pying lesions. On review of the world literature, we cerebral embolism of cardiac echinococcosis, the sur- were able to ®nd about 60 cases of secondary multiple gical removal of the primary source is important to hydatid cysts of the brain reported to date [3]. Of these prevent multiple recurrences due to embolism.
cases reported in the literature, only six (%10) were caused by embolization from the rupture of intra- cardiac hydatidosis. Our case is the seventh case. Be- 1. Sharma A, Abraham J (1982) Multiple giant hydatid cysts of the cause of their indolent nature, hydatid cysts may not brain. Case report. J Neurosurg 57: 413±415 cause focal neurological signs until they are very large.
2. Sierra J, Oviedo J, Berheir M, Leiguarda R (1985) Growth rate of secondary hydatid cysts of the brain. J Neurosurg 62: 781±782 Raised intracranial pressure secondary to mass e¨ect is 3. Turgut M, Benli K, Eryilmaz M (1997) Secondary intracranial usually the clinical sign [1, 2]. There was papilloedema, hydatid cysts caused by intracerebral embolism of cardiac echi- and left hemiparesis in our case. Computerised to- nococcosis: an exceptional case of hydatidosis. J Neurosurg 86: mography is an excellent imaging method that local- 4. Vaquero J, Jimenez C, Martinez R (1982) Growth of hydatid ises the lesions and may be used to predict the histo- cysts evaluated by CT scanning after presumed cerebral hydatid logical nature of the cyst structure. [4] Treatment embolism. Case report. J Neurosurgery 57: 837±838 consists of isolation of the patient from the source of Correspondence: Nihat Egemen, M.D., Esat Caddesi 97/3 KuÈcËuÈk infection, antiparasitic drugs and surgical removal of

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