Journal of Neurosciences in Rural Practice
 


 
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CASE REPORT
Year : 2018  |  Volume : 9  |  Issue : 4  |  Page : 622-624  

Cerebral hydatid cyst in a young immunocompromised patient in Parakou


1 Department of Neurology, Faculty of Medicine, University of Parakou; Department of Neurology, University Departmental Hospital of Parakou, Parakou, Benin
2 Department of Neurology, University Departmental Hospital of Parakou, Parakou, Benin

Date of Web Publication29-Aug-2018

Correspondence Address:
Thierry Adoukonou
Department of Neurology, University of Parakou, Parakou
Benin
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnrp.jnrp_76_18

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   Abstract 


We report the case of a 30-year-old human immunodeficiency virus (HIV)-positive HIV patient who was poorly followed. She was admitted on November 30, 2017, for the management of febrile encephalitis syndrome with motor deficit of the left hemicorps and generalized seizures. In biology, we found a nonspecific inflammatory syndrome. The cerebral imaging without and with injection found a cystic formation multilobed right fronto-parietal of approximately 83 mm × 62 mm, the presence of an annular calcification of approximately 8 mm with a commitment under falcator, and a contralateral ventricle dilation. Treatment with antiepileptic, antibiotic, antiparasitic, and corticosteroid therapy was marked by death the day before the neurosurgical procedure after initial improvement.

Keywords: Cerebral cyst, human immunodeficiency virus, hydatid cyst


How to cite this article:
Adoukonou T, Accrombessi D, Agbetou M. Cerebral hydatid cyst in a young immunocompromised patient in Parakou. J Neurosci Rural Pract 2018;9:622-4

How to cite this URL:
Adoukonou T, Accrombessi D, Agbetou M. Cerebral hydatid cyst in a young immunocompromised patient in Parakou. J Neurosci Rural Pract [serial online] 2018 [cited 2018 Dec 18];9:622-4. Available from: http://www.ruralneuropractice.com/text.asp?2018/9/4/622/239848




   Introduction Top


Hydatidosis is a rare cosmopolitan disease caused by the accidental infestation of man with the tapeworm Echinococcus granulosus (echinococcus), a parasite of canids.[1] The hydatid cyst can lodge in several viscera of the human body and the most usual ones are liver, lungs, and brain. The positive diagnosis is mainly imaging showing a characteristic appearance. The cerebral hydatid cyst is rarely reported in our country.


   Medical Observation Top


We report the case of a 30-year-old woman who has been immunosuppressed to the human immunodeficiency virus (HIV) for 6 years and was on high-active antiretroviral therapy and who was not observant. She was admitted on November 30, 2017, for the management of motor deficit of the left side of rapidly progressive installation. The story reveals an onset dating back to March 2017 with the onset of fever, episodes of generalized tonic–clonic epileptic seizures, and motor deficit of the left hemibody that appeared 2 months later.

After wandering in several health centers, she consulted a neurologist 8 months after the onset of signs, At the admission the examination showed a deterioration of general state, she was sleepy with decrease of consciousness with a Glasgow Coma Scale of 12 (E3V4M5); motor weakness in left side and bilateral Babinski sign. Biology test showed the HIV-positive with HIV1; the blood cell count showed predominantly lymphocytic leukocytosis and C-reactive protein at 40 mg/L. The cerebral computed tomography (CT) without and with injection found a cystic formation multiseptate right parietal fronto of approximately 83 mm × 62 mm and the presence of an annular calcification of approximately 8 mm. There is falcorial involvement and contralateral ventricular dilatation [Figure 1] and [Figure 2]. Based on CT-scan images, a diagnosis of cerebral hydatid cyst was made. She was hospitalized and treated with phenobarbital, clonazepam, adjunctive corticosteroid therapy, albendazole, and cotrimoxazole. Thirty-six hours after the beginning of the treatment, there was an improvement of the general state, of the state of consciousness, and of the motor deficit with a muscular force to 3/5 and a stop of the epileptic seizures. A neurosurgical intervention was proposed, but the patient and her family decided to return against medical advice for financial reasons. She returned 6 weeks later in a state of epilepticus and was transferred to intensive care. The surgery was finally accepted and scheduled for January 30, 2018, but unfortunately, she died the morning of January 30, 2018.
Figure 1: Cerebral computed tomography – scan without injection

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Figure 2: Computed tomography – scan with injection

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   Discussion Top


The hydatid cyst, also called hydatid echinococcosis or hydatidosis, is a parasitic disease caused by E. granulosus. It is a parasite that touches the human body through animal contact. It is a cosmopolitan disease, found mainly in traditional sheep-rearing countries (developing countries) and sometimes a real public health problem.[1] Brain localization is rare (1%–4% of cases). It occurs mainly in children and young adults, with a clear predominance of the male sex.[2],[3],[4] The circumstances of discovery are not specific and the clinic may be dominated by signs of intracranial hypertension (HTIC), convulsive seizures, motor and/or sensory deficit signs, as well as disorders of consciousness. A cerebellar syndrome may also be observed in rare cases since the preferred location of the cyst at the cerebral level is the white matter at the supratentorial stage. The location under tentorial is rare.[4],[5],[6] The diagnosis of certainty is with brain imaging (CT or magnetic resonance imaging). There is no specific biological assessment of orientation (hydatid serology often negative), and the diagnosis of certainty is done at the cerebral scanner which reports a pathognomonic aspect. It is a well-circumscribed liquid mass as “drawn with compass,” spherical or oval of variable size (often bulky in the child), united or multivesicular with thin wall, and unmodified after injection of contrast medium.[4],[6]

The differential diagnosis is done with:[6]

  • Cystic astrocytoma – its edges are irregular, its wall is thick with a nodule wall
  • Porencephalic cavities and arachnoid cysts (peripheral seat and nonspherical shape)
  • Squamous cyst – more irregular contours and heterogeneous density
  • A brain abscess.


Once identified, hydatidosis should be treated by surgery or by a technique called aspiration puncture. In the absence of treatment, the spontaneous involution of the cyst is very rare; the evolution toward the calcification is exceptional (1% of the cases) and indicates their chronicity.[3],[4],[7],[8]


   Conclusion Top


The hydatid cyst of the brain remains a rare condition. There is no biological assessment of orientation. Only cerebral imaging makes it possible to pose the diagnosis of certainty with its characteristic appearance. The management is essentially surgical. Prevention is the only way to eradicate the cyst.

Declaration of patient consent

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

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
González-Ruiz CA, Isla A, Pérez-Higueras A, Blázquez MG. Unusual CT image of a cerebral hydatid cyst. Pediatr Radiol 1990;20:283-4.  Back to cited text no. 1
    
2.
Hamdi A, Ayachi R, Gargari R, Mourad A. The hydatid cyst of the brain. About 14 cases. Ann Chir 1994;44:226-30.  Back to cited text no. 2
    
3.
Micheli F, Lehkuniec E, Giannaula R, Caputi E. Calcified cerebral hydatid cyst. Eur Neurol 1987;27:1-4.  Back to cited text no. 3
    
4.
El Khamlichi A, El Ouahabi A, El Amrani F, Assamti O. Growth of intracerebral hydatid cyst evaluated by computed tomography (1case). Neurochirurgie 1990;36:312-4.  Back to cited text no. 4
    
5.
Ozkan U, Kemaloglu MS, Selçuki M. Gigantic intracranial mass of hydatid cyst. Childs Nerv Syst 2001;17:623-5.  Back to cited text no. 5
    
6.
El Abbassi-Skalli A, Gharbi A, Adil A, Abdelouafi A, Kadiri R. Kyste hydatique cérébral. Apport de la scanographie. J Neuroradiol 2000;27:196-9.  Back to cited text no. 6
    
7.
Peter JC, Domingo Z, Sinclair-Smith C, de Villiers JC. Hydatid infestation of the brain: Difficulties with computed tomography diagnosis and surgical treatment. Pediatr Neurosurg 1994;20:78-83.  Back to cited text no. 7
    
8.
Rudwan MA, Khaffaji S. CT of cerebral hydatid disease. Neuroradiology 1988;30:496-9.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

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