Cerebrospinal Fluid Analysis

Cerebrospinal fluid (CSF) analysis is a diagnostic tool for many conditions affecting the central nervous system. Urgent indications for lumbar puncture include suspected central nervous system infection or subarachnoid hemorrhage. CSF analysis is not necessarily diagnostic but can be useful in the evaluation of other neurologic conditions, such as spontaneous intracranial hypotension, idiopathic intracranial hypertension, multiple sclerosis, Guillain-Barré syndrome, and malignancy. Bacterial meningitis has a high mortality rate and characteristic effects on CSF white blood cell counts, CSF protein levels, and the CSF:serum glucose ratio. CSF culture can identify causative organisms and antibiotic sensitivities. Viral meningitis can present similarly to bacterial meningitis but usually has a low mortality rate. Adjunctive tests such as CSF lactate measurement, latex agglutination, and polymerase chain reaction testing can help differentiate between bacterial and viral causes of meningitis. Immunocompromised patients may have meningitis caused by tuberculosis, neurosyphilis, or fungal or parasitic infections. Subarachnoid hemorrhage has a high mortality rate, and rapid diagnosis is key to improve outcomes. Computed tomography of the head is nearly 100% sensitive for subarachnoid hemorrhage in the first six hours after symptom onset, but CSF analysis may be required if there is a delay in presentation or if imaging findings are equivocal. Xanthochromia and an elevated red blood cell count are characteristic CSF findings in patients with subarachnoid hemorrhage. Leptomeningeal carcinomatosis can mimic central nervous system infection. It has a poor prognosis, and large-volume CSF cytology is diagnostic.

Case report: multiple and atypical amoebic cerebral abscesses resistant to treatment

BACKGROUND

The parasite Entamoeba histolytica is the causal agent of amoebiasis, a worldwide emerging disease. Amebic brain abscess is a form of invasive amebiasis that is both rare and frequently lethal. This condition always begins with the infection of the colon by E. histolytica trophozoites, which subsequently travel through the bloodstream to extraintestinal tissues.

CASE PRESENTATION

We report a case of a 71-year-old female who reported an altered state of consciousness, disorientation, sleepiness and memory loss. She had no history of hepatic or intestinal amoebiasis. A preliminary diagnosis of colloidal vesicular phase neurocysticercosis was made based on nuclear magnetic resonance imaging (NMRI). A postsurgery immunofluorescence study was positive for the 140 kDa fibronectin receptor of E. histolytica, although a serum analysis by ELISA was negative for IgG antibodies against this parasite. A specific E. histolytica 128 bp rRNA gene was identified by PCR in biopsy tissue. The final diagnosis was cerebral amoebiasis. The patient underwent neurosurgery to eliminate amoebic abscesses and was then given a regimen of metronidazole, ceftriaxone and dexamethasone for 4 weeks after the neurosurgery. However, a rapid decline in her condition led to death.

CONCLUSIONS

The present case of an individual with a rare form of cerebral amoebiasis highlights the importance of performing immunofluorescence, NMRI and PCR if a patient has brain abscess and a poorly defined diagnosis. Moreover, the administration of corticosteroids to such patients can often lead to a rapid decline in their condition.

Molecular and Histologic Diagnosis of Central Nervous System Infections

Infections of the central nervous system cause significant morbidity and mortality in immunocompetent and immunocompromised individuals. A wide variety of microorganisms can cause infections, including bacteria, mycobacteria, fungi, viruses, and parasites. Although less invasive testing is preferred, surgical biopsy may be necessary to collect diagnostic tissue. Histologic findings, including special stains and immunohistochemistry, can provide a morphologic diagnosis in many cases, which can be further classified by molecular testing. Correlation of molecular, culture, and other laboratory results with histologic findings is essential for an accurate diagnosis, and to minimize false positives from microbial contamination.

Overview of the effect and epidemiology of parasitic central nervous system infections in African children

Infections of the central nervous system are a significant cause of neurologic dysfunction in resource-limited countries, especially in Africa. The prevalence is not known and is most likely underestimated because of the lack of access to accurate diagnostic screens. For children, the legacy of subsequent neurodisability, which affects those who survive, is a major cause of the burden of disease in Africa. Of the parasitic infections with unique effect in Africa, cerebral malaria, neurocysticercosis, human African trypanosomiasis, toxoplasmosis, and schistosomiasis are largely preventable conditions, which are rarely seen in resource-equipped settings. This article reviews the current understandings of these parasitic and other rarer infections, highlighting the specific challenges in relation to prevention, diagnosis, treatment, and the complications of coinfection.

Immunodiagnosis of CNS parasitic infections

The nature of many parasitic infections of the central nervous system (CNS) requires immunodiagnosis to confirm presumptive diagnoses. The CNS is the primary site of parasite infection for some parasitic organisms and for others, neurological infection occurs only in immunocompromised hosts. Still other parasites cause ectopic infections of the CNS and occur very rarely. This review concentrates on laboratory diagnosis of diseases that are caused by parasites with a primary predilection for the CNS. Emphasis is placed on laboratory diagnostic methods that are used and suitable for clinical diagnosis, rather than a comprehensive review of all the experimental methods that have been reported in the literature. Immunodiagnosis is not appropriate for the diagnosis of all parasitic infections of the CNS; in those cases, alternative diagnostic methods are presented, but not discussed in detail. In some instances potential new antigens or methods are presented, particularly if adoption of these methods is expected in the near future.

[Neuroradiologic imaging results suggestive of parasitic cysts in central nervous system in course of neoplastic disorders--cases report]

Cystic changes within CNS, revealed by computed tomography or magnetic resonance imaging, pose difficult diagnostic and therapeutic problem. We present two patients with primary diagnosis of parasitic cysts of CNS, in whom neoplastic etiology was finally confirmed. Differential diagnosis of cystic foci should from the beginning include not only parasitic infections, but also neoplastic diseases, which are much more frequent in Poland at present and in which prolonged diagnostic process and delayed treatment is highly unfavorable.

[Parasitic and fungal neuroinfections at the Infectious Diseases Clinic in Fann Teaching Hospital in Dakar]

OBJECTIVES

This retrospective study was carried out to describe the epidemiological, clinical and aetiological profile of parasitic and fungal neuroinfections at the Infectious Diseases Clinic in Fann Teaching Hospital in Dakar.

PATIENTS AND METHODS

Data were collected for analysis from patients files recorded from January 1, 2001 to December 31, 2003.

RESULTS

We found 126 cases of parasitic and fungal neuroinfections, representing 62% of the total of neuroinfections cases (126/203) and 27% of cerebro-meningeal diseases encountered at the clinic during the study period (126/470). Sex ratio M/F was 1.7 and the mean age of patients was 32 years +/- 14.4. Thirty seven patients (30%) were HIV seropositive. Aetiologies were represented by cerebral malaria (85 cases), neuromeningeal cryptococcosis (37 cases) and toxoplasmosis (4 cases). The overall case fatality rate was 38% (48 deaths/126). The fatality rate varied according to aetiologies: 27% in cerebral malaria, and 59.5% in neuromeningeal cryptococcosis that was found mainly among HIV positive patients (34 cases/37).

CONCLUSION

These results give evidence of the frequency and the gravity of the adult's cerebral malaria in Dakar, but also the growing place of the neuromeningeal cryptococcosis in the neuromeningeal opportunist pathology of HIV positive patients.

Neurohydatidosis

Early and non-invasive evaluation of hydatid infestation of brain and spine is of paramount importance, especially in endemic areas. We present a spectrum of imaging findings in neurohydatidosis with a brief review of literature.

Echinococcosis presenting as an otogenic brain abscess: an unusual lesion of the middle ear cleft and temporal lobe

This paper presents a case of a 28-year-old male with a seizure episode and a 4-year history of intermittent tinnitus on the left ear. On computed tomography and magnetic resonance imaging, a density with rim enhancement was found at the temporal lobe, associated with mastoid tegmen destruction and middle ear mass, indicating cholesteatoma with complicating brain abscess. Evacuation of the brain abscess was performed with a combined otolaryngologic and neurosurgical procedures (canal wall-down mastoidectomy and temporal craniotomy). The pathology turned out to be infestation with Echinococcus granulosus.

Cerebral alveolar echinoccosis mimicking primary brain tumor

We present a case of cerebral infestation by Echinococcosis multilocularis mimicking an infiltrative primary brain tumor. A heavily calcified mass invading the midbrain enhanced in a cauliflower-like fashion with small peripheral nodules present on MR imaging. Perfusion-weighted MR imaging revealed low relative cerebral blood volume within the calcified lesion and peripheral hyperemia. Single-voxel proton MR spectroscopy with an echo time of 135 milliseconds was normal.

Intraprostatic hydatid cyst: an unusual presentation

A case of intraprostatic cyst is reported. The patient presented with a completely evacuated hydatid cyst of the prostate. The intraprostatic cystic cavity that was communicating with the urethra developed urinary stones. The patient had transurethral resection of the prostate, the stones in the cyst were pushed into the bladder and fragmented using a ballistic lithotripter. Pathological examination concluded to a prostatic hydatid cyst that had evacuated through the urethra and was complicated by stone formation within the residual cavity. Postoperative course was uneventful and follow-up did not show evidence of recurrence. This is the first case of hydatid cyst of the prostate to present as an intraprostatic stone pouch.

Secondary infection of intracranial hydatid cyst with Clostridium ramosum

INTRODUCTION

Brain involvement in hydatid disease occurs in 1-2% of all Echinococcus granulosus infections. Secondary infection of intracranial hydatid cysts is extremely rare.

CASE REPORT AND DISCUSSION

In this case report, we present a secondary infection of an intracranial hydatid cyst due to Clostridium ramosum, which is an extremely rare infectious pathogen in neurosurgical practice, and a potential pitfall in neuroradiological investigations.

[Parasitic diseases in the central nervous system]

Along with the drastic decrease of soil-transmitted intestinal helminthiases, parasitic diseases in general are ignored, or considered as the disease of the past, in Japan. However, due to the Japanese food culture of eating raw materials, food-borne parasitic diseases are still present in Japan. The majority of food-borne parasitic diseases are zoonotic, and caused by ectopic migration of parasite larvae. They accidentally migrate into CNS to cause deleterious conditions. Clinicians should always remind about the possibility of parasitic diseases when they make differential diagnosis for CNS diseases.

Primary intracranial hydatid cyst in the interpeduncular cistern

Cerebral involvement in hydatid disease occurs in 1-4% of cases. There are few documented cases in the literature of intracranial hydatid cysts in unusual locations such as pons and thalamus. In this report, a case of 33-year-old male with primary intracranial hydatid cyst in the interpeduncular cistern is reported. This is the first such case in the literature.

Granulomatous diseases of the central nervous system

Infectious diseases of the central nervous system (CNS), particularly those accompanied by the formation of granulomas, are a constant diagnostic challenge in some specific regions of the world, above all in developing countries. The pattern of image seen on CT or MR scan is the result of the inter-relations between the individual characteristics of the infectious agent and the capacity of each host to mount an appropriate inflammatory response to that specific type of aggression, inside one particular compartment of the CNS. Taking these parameters into account we will discuss the several patterns of image found in parasitic, bacterial, and fungal granulomatous infections.

Ophthalmomyiasis (interna posterior) of the posterior segment and central nervous system myiasis: Cuterebra spp. in a cat

A unilateral ophthalmomyiasis posterior in a 5-year-old female spayed Domestic Long-haired cat of a third or fourth stage instar Cuterebra spp. larvae is reported. The cat was presented for depression and anorexia. The organism was found on physical examination at presentation. The cat was euthanized because of the worsening systemic condition. The larva was demonstrated by histopathology with coagulation necrosis and hemorrhage of the optic nerve, retina and choroid, and anterior uveitis. No significant cerebrum and anterior brain stem lesions were found.

Multiple organ involvement hydatid cysts in a 2-year-old boy

The cerebral hydatid cysts caused by Echinococcus granulosus are rare and occur mostly during childhood in endemic areas. A 2-year-old boy was admitted with focal neurological signs in the left extremities. Magnetic resonance imaging of the brain showed a cyst lying from right parietooccipital region to the lateral ventricle. There were also multiple cysts in his lung and liver. The cerebral hydatid cyst was surgically extracted without complications. We suggest that a differential diagnosis of hydatid cyst should be considered when a brain mass is found in a patient, even 2 years old, from an endemic area of echinococcosis.

[Investigation of inpatient cases of food-borne parasitic encephalopathy]

OBJECTIVE

To investigate the clinical features of the patients with encephalopathy caused by food-borne parasites.

METHODS

Questionnairing was carried out to collect and analyze clinical data of cerebral form of food-borne parasitic diseases in the hospital during the past five years.

RESULTS

Among 190 discharged medical histories, 115 cases were valid for investigation, the number of males was 73, females 42, with a ratio of 1.74:1. Among these patients, 20.9% (24/115) had a history of eating raw meat. For discharge diagnosis, neurocysticercosis accounted for 92.2% (106/115), cerebral paragonimiasis 3.5% (4/115), sparganosis 2.6% (3/115), and angiostrongyliasis cantonensis and gnathostomiasis 0.9% (1/115) each. 13.9% (16/115) of the patients were hospitalized for three times or more.

CONCLUSION

More attention should be paid to food-borne parasitic encephalopathy.

Chronic cerebral paragonimiasis combined with aneurysmal subarachnoid hemorrhage

A 67-year-old Korean woman attended our hospital complaining of a severe headache. A brain computed tomography scan showed conglomerated, high-density, calcified nodules in the left temporo-occipito-parietal area and high-density subarachnoid hemorrhage in the basal cisterns. Magnetic resonance imaging of the brain shows multiple conglomerated iso- or low-signal intensity round nodules with peripheral rim enhancement. She underwent craniotomies to clip the aneurysm and remove the calcified masses. Paragonimus westermani eggs were identified in the calcified necrotic lesions. Results of parasitic examinations on the sputum and an enzyme-linked immunosorbent assay for P. westermani were all negative. The patient presented with headache and dizziness that had occurred for more than 30 years. She had not eaten freshwater crayfish or crabs. However, she had sometimes prepared raw crabs for several decades. Overall, this case was diagnosed as chronic cerebral paragonimiasis, in which she may have been infected through the contamination of utensils during the preparation of the second intermediate hosts, combined with a cerebral hemorrhage.

Parasitic worms of the central nervous system: an Australian perspective

The diagnosis and management of parasitic diseases of the central nervous system (CNS) is difficult, even for infectious diseases physicians and neurologists. Furthermore, few overviews of the spectrum of causative helminths and clinical syndromes have been published. In the present study, we review the seven most common parasitic diseases of the CNS: (i) cysticercosis, (ii) neuroschistosomiasis, (iii) paragonimiasis, (iv) angiostrongyliasis, (v) hydatid disease, (vi) sparganosis and (vii) gnathostomiasis. Major syndromes of parasitic disease of the CNS and their differential causes are discussed, including: (i) cystic lesions, (ii) enhancing granulomas (with and without creeping subcutaneous eruptions), (iii) eosinophilic meningoencephalitis and (iv) spinal cord disease. Specific risk factors that predispose to these infections are also discussed and particular attention is drawn to the situation in Australia.

Submandibular and intracranial hydatid cyst in an adolescent

OBJECTIVES

An unusual case of hydatid disease is reported. Review of the pertinent literature did not reveal any hydatid disease located simultaneously in both the intracranial and submandibular glands. This is the first case with hydatid disease occurring in both locations at the same time.

STUDY DESIGN

The case of an 18-year-old is presented; the symptoms, findings, methods of diagnosis, and our approach for treatment are discussed; and the literature is reviewed.

RESULTS

The intracranial lesion was completely excised by left-sided frontoparietal craniotomy, and the mass in the right side of the submandibular gland was removed through a submandibular approach at the same session. The intact cyst was completely excised. Histological examination of both lesions confirmed the diagnosis of hydatid cyst by. Postoperative recovery was uneventful, and the patient was discharged on the seventh day.

CONCLUSIONS

Hydatid cyst should be suspected during the evaluation of cervical masses, particularly in endemic regions. Hydatid disease infestations are best treated with complete excision of the intact cyst.

[Imaging of a historical case of vertebral hydatidosis]

Radiological, computed tomography and magnetic resonance imaging findings in a case of spinal hydatidosis are reported.

Neural sarcocystosis in a straw-necked ibis (Carphibis spinicollis) associated with a Sarcocystis neurona-like organism and description of muscular sarcocysts of an unidentified Sarcocystis species

A Sarcocystis neurona-like parasite was associated with acute sarcocystosis in the brain of an ibis (Carphibis spinicollis). Numerous schizonts and merozoites were found extravascularly in encephalitic lesions. These schizonts reacted positively with anti-S. neurona and anti-S. falcatula polyclonal antibodies in an immunohistochemical test. Sarcocysts of an unidentified Sarcocystis species were present in the brain, heart, and skeletal muscles. Sarcocysts in skeletal muscles were microscopic, and the sarcocyst wall was up to 3 microm thick. The villar protrusions on the sarcocyst wall were up to 4.5 microm long, constricted at the base, and expanded laterally. Schizonts and sarcocysts distinct from those of S. falcatula.

[Neurotrichinosis]

INTRODUCTION

Trichinellosis is an anthropozoonosis caused by Trichinella spiralis. Central nervous system complications can occur during the course of this disease. This paper presents a case of neurotrichinellosis, assayed by using indirect immunofluorescence test.

CASE REVIEW

A patient aged 30, was admitted to the Clinic on the fifth day after onset of the disease, which was gradual, starting with flu-like symptoms. Two days before admittance, the diseased became somnolent, disconcerted and disoriented. On admission, the patient was highly febrile (39 degrees C), dehydrated, with eyelid edema. Right hemiparesis was present. The disease was confirmed by indirect immunofluorescence test, showing an increase of trichinella antibody titre (1:20, 1:160 and 1:640). The cerebrospinal fluid was cytobiochemically normal. Electroencephalographic findings exhibited a moderate cerebral dysfunction. Multifocal unspecific changes were established by magnetic tomography. The diseased was treated by mebendazole and prednisolone. The course of the disease was favourable and the patient was cured without sequelae.

DISCUSSION

Recognition and diagnosis of Trichinellosis are complicated due to its polymorphid symptomatology. In the case reviewed, the disease started with clinical features of flu-like symptoms and febrile gastroenteritis. According to some authors, central nervous system manifestations occurred in 10-15% of the diseased.

CONCLUSION

When examining clinically manifested encephalitis, Trichinelosis should be taken into consideration as a cause of the disease.

Clinics in diagnostic imaging (58). Chronic cerebral paragonimiasis

A 36-year-old Korean man presented with a history of epilepsy. MR imaging of the brain revealed multiple conglomerated round nodules that were hypointense on both T1-and-T2 weighted images. These were located at the left temporal and occipital lobes and had surrounding encephalomalacia. CT scan confirmed the presence of large calcified nodules in the corresponding regions. These imaging findings were typical of chronic cerebral paragonimiasis. The clinical, CT and MR features of cerebral paragonimiasis are reviewed.

Infections of the central nervous system in transplant recipients

Central nervous system (CNS) infections, accounting for 4-29% of CNS lesions in transplant recipients, are a significant post-transplant complication. Focal CNS infectious lesions or brain abscesses have been documented in 0.36-1% of the transplant recipients. Mycelial fungi, particularly Aspergillus, are by far the most frequent etiologies of post-transplant brain abscesses. Bacteria, with the exception of Nocardia, are rarely associated with brain abscesses in transplant recipients. Time of onset and concurrent extraneural lesions have implications relevant towards invasive diagnostic procedures in transplant recipients with brain abscesses. Meningoencephalitis in transplant recipients is predominantly due to viruses, e.g., herpesviruses, and less frequently due to Listeria monocytogenes, Toxoplasma gondii, and Cryptococcus. Despite a wide, and at times perplexing array of opportunistic pathogens that can cause CNS infections, the temporal association of the infection with the time elapsed since transplantation, risk factors, clinical manifestations, and neuroimaging characteristics of the lesion can allow a reasoned and rational approach towards the recognition, diagnosis, and appropriate management of CNS infections in transplant recipients.

Central nervous system hydatidosis in Turkey: a cooperative study and literature survey analysis of 458 cases

OBJECT

Hydatidosis is both a medical and an economic problem in Turkey. The aim of this study was to analyze central nervous system (CNS) involvement in this disease, the related problems the disease causes, and its diagnostic and therapeutic aspects.

METHODS

The authors conducted an extensive literature survey of the subject, in which papers published by Turkish authors in international and domestic journals were carefully analyzed. In addition, the authors conducted a cooperative study in which data were gathered from 47 neurosurgery departments across the country. The purpose was to determine the current status of the disease in Turkey; thus, each unit was questioned about their experience over the past 5 years. Contrary to common belief, the incidence of hydatidosis has not decreased significantly in Turkey. However, computerized tomography and magnetic resonance imaging have tremendously increased diagnostic specificity. Incidences of morbidity and mortality have improved over time, according to the results of the cooperative study, although these changes are not statistically significant. This may be attributed to experience that has been gained and to more frequent use of chemotherapy, as reflected by the cooperative study data. The two statistically significant findings of that study were expanded use of chemotherapy in the management of hydatidosis, and a higher rate of extraneural involvement in the disease. The cooperative study revealed that chemotherapy was being used more often and that there was a wider range of indications for this treatment than previously reported. The higher rate of extraneural involvement was predictable because lesions in the CNS are typically secondary in this disease. With regard to the studies' findings on cases of spinal hydatid cysts, the authors found that administration of chemotherapeutic drugs was the only statistically significant parameter (t = 3.78, p < 0.05), with the rate of chemotherapy higher in the cooperative study.

CONCLUSIONS

Morbidity, mortality, and recurrence rates of hydatidosis uncovered by the cooperative study and the literature survey were not statistically significant.

Imaging of rickettsial, spirochetal, and parasitic infections

This article reviews the clinical signs, symptoms, and neuroimaging findings of the commonly known rickettsial, spirochetal, and parasitic infections (cysticercosis is covered elsewhere in this issue). Differential diagnoses and significant imaging characteristics are reviewed to help narrow the diagnostic possibilities. Several of the infections in this disparate group are not seen as commonly as they once were because of advances in early diagnosis, treatment, improvements in sanitation, and prevention of epidemics. Many of the infections, however, are endemic to certain parts of the world and are seen with increasing frequency in immunocompromised individuals.

Parasitic lesion of the insula suggesting cerebral sparganosis: case report

Cerebral sparganosis, a parasitic disease, rarely produces a chronic active inflammatory response in the brain. Clinically and radiographically the process may mimic a neoplasm. We report a 30-year-old man who underwent surgical exploration for a mass in the insular cortex. Histology revealed a densely fibrotic mass heavily infiltrated with plasma cells and lymphocytes, in which were embedded parasitic forms consistent with sparganosis. We describe the MRI appearances and pathologic features. Intracranial mass lesions secondary to sparganosis must be considered in patients with a history of travel to endemic areas, especially Asia.

MRI of cerebral alveolar echinococcosis

Cerebral alveolar echinococcosis is rare. We report a case with multiple intracranial masses which show cauliflower-like contrast enhancement pattern on MRI. The lesions originated from hepatic involvement with invasion of the inferior vena cava.

[Inflammatory and infectious manifestations of the nervous system]

The Central Nervous System is the site of a wide variety of inflammatory and infectious diseases. Some disease entities have been in the focus of interest in recent years and progress has been achieved in our understanding of some chosen domains. We will review recent progress in our knowledge about transmissible spongiformes encephalopathies and AIDS-associated lesions, and briefly discuss cerebral vasculitis, granulomatous diseases and the most frequent infections by parasites.

Cerebral hydatid cysts in children

A parasitic tapeworm, called Taneia Echinococcus, causes hydatid disease. Hydatid disease is endemic in sheep and cattle-raising areas of the world. Hydatid disease of the central nervous system constitutes 2%-3% of all reported cases of hydatid cysts. In our institution, 23 children underwent surgery for intracranial hydatid cysts between 1979 and 1995. There were 14 boys and 9 girls, aged between 3 to 16 years (mean 8.8 years). Signs and symptoms were related to the site and size of the cyst. Headache and vomiting due to increased intracranial pressure were the most common presenting symptoms. A round cystic lesion without perifocal edema and rim enhancement is the characteristic appearance on a computed tomography (CT) scan. A magnetic resonance image visualizes cyst location better than CT. Associated systemic hydatidosis in four of our patients involved kidney, liver, lung, and liver and lung, respectively. Intact cyst removal was achieved in 14 patients. In three patients with infected or inflamed hydatid disease, the ruptured cyst capsule was totally resected. Aspiration and extirpation were performed in only one patient. Eleven patients were treated with chemotherapeutic agents such as albendazole or mebendazole due to cyst rupture during surgery or associated systemic hydatid disease. Hydatid disease can also be seen in Western countries because of travel and migration. Cerebral hydatid cyst should be kept in mind for the differential diagnosis of cystic lesions.

Isolated cerebral hydatid cysts: a comparative study of two different types of presentations

OBJECTIVES

To demonstrate the existence of two imaging patterns of cerebral hydatidosis and discuss its clinical importance.

MATERIAL AND METHODS

A retrospective review of six cases of cerebral hydatidosis using various imaging techniques including CT, MRI, angiography and cystogram.

RESULTS

Clinically the most common findings included papilloedema, headache and vomiting. Two of the cases reported recurrence of symptoms and were reoperated. The first 4 cases presented the classical signs of unilocular well defined cysts while the last two cases had multilocular, often polygonal cysts with perifocal edema, calcification and membrane detachment.

CONCLUSION

Two radiologically and pathologically distinct subtypes of hydatidosis exist. Division into groups may assist decision over treatment protocol.