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IMAGES IN NEUROLOGY
Year : 2011  |  Volume : 14  |  Issue : 3  |  Page : 217-218
 

Cerebral hydatid cyst showing pathognomonic daughter cysts


Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India

Date of Submission19-Jan-2011
Date of Decision09-Mar-2011
Date of Acceptance31-Mar-2011
Date of Web Publication11-Oct-2011

Correspondence Address:
Mukund R Vidhate
Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh - 226 003
India
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DOI: 10.4103/0972-2327.85903

PMID: 22028541

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How to cite this article:
Vidhate MR, Singh D, Sharma P, Singh MK. Cerebral hydatid cyst showing pathognomonic daughter cysts. Ann Indian Acad Neurol 2011;14:217-8

How to cite this URL:
Vidhate MR, Singh D, Sharma P, Singh MK. Cerebral hydatid cyst showing pathognomonic daughter cysts. Ann Indian Acad Neurol [serial online] 2011 [cited 2014 Nov 26];14:217-8. Available from: http://www.annalsofian.org/text.asp?2011/14/3/217/85903


A 45-year-old woman presented with intermittent, generalized, moderate intensity headache for last 6 months. She had no history of associated vomiting, diplopia, seizures, or fever. The central nervous system (CNS) examination was normal, except for the presence of papilledema on fundoscopic examination. Routine laboratory investigations were within normal limits. MRI of the brain showed multiple, spherical, homogenously cystic lesions having well-defined smooth wall. The cyst fluid was isointense with CSF on T 1 - and T 2 -weighted images [Figure 1]. Also noted were the daughter cysts within cystic lesion in the right frontoparietal region [Figure 2]. Post gadolinium-contrast image revealed minimal rim enhancement [Figure 3]. No calcification or perilesional edema was seen. Based on neuroimaging findings, the patient was diagnosed as having cerebral hydatid cysts. USG of the abdomen and CT of chest did not reveal any cysts within the liver and lungs, respectively. The patient was operated and histopathology was consistent with Echinococcus granulosus infestation.
Figure 1: Axial T2-weighted image showing multiple, spherical, homogenously cystic lesions having well-defi ned, smooth wall (arrows)

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Figure 2: Axial T2 FLAIR image showing well-defi ned, large cyst in the right frontoparietal region showing pathognomonic daughter cysts within (arrowheads)

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Figure 3: Axial T1-weighted image after gadolinium contrast showing minimal rim enhancement (arrows)

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Cerebral hydatid disease is a rare parasitic infestation caused by larval stage of E. granulosus and E. multilocularis, accounting for 2% of all intracranial space occupying lesions even in high endemic countries. [1] Isolated cerebral hydatid disease is rarely reported and the exact incidence is unknown. [2] Children are most commonly affected with symptoms of raised intracranial tension and focal neurologic deficits. Multiple intracranial cysts are rare. [3] MRI reveals well-defined, smooth, thin-walled, spherical, homogeneous cystic lesions. Appearance of the cyst fluid is similar to that of CSF on T 1 - and T 2 -weighted images. The cyst wall usually shows a rim of low signal intensity on both T I - and T 2 -weighted images. Rim enhancement, perifocal edema, and calcification are rare features. The presence of daughter cysts is considered pathognomonic, but rarely reported. The differential diagnosis includes pyogenic or fungal abscess, cystic astrocytoma, arachnoid cyst, and porencephalic cyst. [4],[5]

 
   References Top

1.Tlili-Graiess K, El-Ouni F, Gharbi-Jemni H, Arifa N, Moulahi H, Mrad-Dali K, et al. Cerebral hydatid disease: Imaging features. J Neuroradiol 2006;33:304-18.  Back to cited text no. 1
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2.Karak PK, Mittal M, Bhatia S, Mukhopadhyay S, Berry M. Isolated cerebral hydatid cyst with pathognomonic CT sign. Neuroradiol 1992;34:9-10.  Back to cited text no. 2
    
3.Gupta S, Desai K, Goel A. Intracranial hydatid cyst: A report of 5 cases and review of literature. Neurol India 1999;47:214-17.  Back to cited text no. 3
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4.Bukte Y, Kamanoglu S, Nazaroglu h, Ozkan U, ceviz A, Simsek m. cerebral hydatid disease: CT and MR imaging findings. Swiss Med Wkly 2004;134:459-67.  Back to cited text no. 4
    
5.Tuzun M, Altinors N, Arda IS, Hekimoglu B. Cerebral hydatid disease CT and MR findings. Clin Imaging 2002;26:353-7.  Back to cited text no. 5
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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