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Images in Neurology |

Large Solitary Cerebral Hydatid Cyst

Carla Bartosch, MD; Carina Reis, MD; Ligia Castro, MD
Arch Neurol. 2011;68(7):946-947. doi:10.1001/archneurol.2011.145.
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A 6-year-old boy from Romania with an 8-month history of progressive right-sided weakness developed a left parietal headache and refused to eat for 2 days. He appeared to be well developed and nourished, without fever or vomiting. Examination showed right hemiparesis without facial involvement. Results of routine laboratory examinations were within normal limits. Magnetic resonance imaging (Figure 1) showed a large (8 cm), well-demarcated cystic lesion in the left frontal lobe with midline shift and left uncal herniation. The lesion's signal intensity was similar to that of cerebrospinal fluid at all sequences, including diffusion. These findings were highly suggestive of hydatid cyst. The cyst was removed intact, using isotonic solution for pericystic space dissection and hydrostatic expulsion. Histologic examination (Figure 2) confirmed the diagnosis. Postoperatively, the patient had rapid recovery from all signs and symptoms.

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Figure 1. Magnetic resonance imaging showing a large, left frontal cyst with signs of mass effect, isointense to cerebrospinal fluid. A, Axial T2 fluid-attenuated inversion recovery–weighted image. B, Axial T2 turbo spin echo–weighted image. C, Axial apparent diffusion coefficient map. D, Sagittal T1 spin echo–weighted image after gadolinium was administered. There was no abnormal enhancement.

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Figure 2. Gross and histological features. A, Surgical specimen consisting of an intact spherical cyst. B, Histologic view of the cyst, showing its hyaline laminated wall and germinative layer with scoleces (hematoxylin-eosin, original magnification ×100). C, Histologic section of several scoleces with hooks (arrows) (hematoxylin-eosin, original magnification ×400).

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