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Year : 2009  |  Volume : 52  |  Issue : 4  |  Page : 571-572
Intraventricular hydatid cyst in a child


1 Department of Pathology, M.S. Ramaiah Medical College and Hospital, Bangalore - 560 054, India
2 Department of Neurosurgery, M.S. Ramaiah Medical College and Hospital, Bangalore - 560 054, India

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Date of Web Publication1-Oct-2009
 

   Abstract 

Hydatid disease is caused by the infestation of the larvae of tapeworms of the genus Echinococcus. The definitive hosts of Echinococcus are various carnivores, the common being the dog. All mammals (more often sheep and cattle) are intermediate hosts. Humans get infected through the feco-oral route by ingestion of food or milk contaminated by dog feces containing ova of the parasite or by direct contact with dogs. The most common sites of infestation are the liver (75%) and lungs (15%). Various authors state a frequency of hydatidosis of the brain ranging between only 0.2-4% of cases. [1],[2],[3] The prognosis following surgical intervention is good, especially in pediatric age. [2],[3] Hence early diagnosis of this condition is crucial. We report a rare case of a child with a large intraventricular hydatid cyst that had an excellent recovery following surgery.

Keywords: Hydatid cyst, intracranial, intraventricular

How to cite this article:
Kamath SM, Mysorekar VV, Rao SG, Varma RG. Intraventricular hydatid cyst in a child. Indian J Pathol Microbiol 2009;52:571-2

How to cite this URL:
Kamath SM, Mysorekar VV, Rao SG, Varma RG. Intraventricular hydatid cyst in a child. Indian J Pathol Microbiol [serial online] 2009 [cited 2014 Sep 20];52:571-2. Available from: http://www.ijpmonline.org/text.asp?2009/52/4/571/56159



   Case Report Top


A six-year-old boy was admitted to the neurosurgical services of our hospital with a history of headache and vomiting of ten days duration. The symptoms were preceded by weakness of the left side of the body since one and a half months. On neurological examination, the child was conscious, obeying commands; pupils were bilaterally equal and reactive to light. There was left hemiparesis. Fundoscopic examination revealed bilateral papilledema. Within a few hours of admission to the hospital the child became deeply unconscious. Cranial computed tomography (CT) scan revealed a large cystic space-occupying lesion in the right temporoparietooccipital region of the lateral ventricle blocking the cerebrospinal fluid (CSF) from the right lateral ventricle [Figure 1]. Hematological and CSF analysis were within normal limits. A right temporoparietal craniotomy and total extirpation of the intraventricular cyst was done [Figure 2]. Preoperatively, precautions were taken for anaphylaxis. Postoperatively, the child received antibiotics, anticonvulsants and steroids.

The gross material submitted for histopathological examination was in the form of multiple irregular pearly white tissue bits amounting to 10 ml. Microscopic examination of the cystic lesion showed a middle acellular cuticular layer and inner germinal layer, attached to which, scolices were seen . A fragmented eosinophilic laminated membrane was also seen [Figure 3]. A histopathological diagnosis of intracranial hydatid cyst was made. The boy showed significant neurological improvement but developed fever, which was treated appropriately. At the time of discharge, the boy was conscious, alert and the left hemiparesis had improved. He reported back after a year with a recurrence of the earlier symptoms. Recraniotomy and excision was done. Histopathology at this stage again revealed a hydatid cyst, which was infected. The postoperative period was uneventful. He has been on follow-up for the last three years with no further radiological or clinical evidence of recurrence of the disease.


   Discussion Top


The incidence of intracranial hydatid in India is 0.2%. [4] Cerebral hydatid disease is extremely rare, being more common in the pediatric population. Intracranial hydatid cysts are more frequently located in the supratentorial compartment. [1] Beskonakli et al., [5] have reported a case of primary intracranial hydatid cyst in the interpeduncular cistern. There are a few documented cases of intracranial hydatid cysts in unusual locations including the parasellar epidural space, sella, cavernous sinus, cerebellum, thalamus and pons. [1],[5] Solitary hydatid cyst in the lateral ventricle, as seen in our case and in one case in the group of patients reported by Gupta et al., [1] is a relatively rare site for intracranial hydatid cyst . In a large series of 29 cases of intracranial and spinal hydatid disease reported from South India, Rumana et al., [6] described the occurrence of uniloculated or multiloculated cysts which were single or multiple. Patients with intracranial hydatid cysts usually present with focal neurological deficit and features of raised intracranial pressure; the latter may be due to the large size or due to interference with the pathway of CSF flow. With the currently available modalities, early diagnosis of intracranial hydatid cyst is possible and important for a better prognosis. The treatment of hydatid cyst is surgical and the aim of surgery is to excise the cyst in toto without rupture to prevent recurrence and anaphylactic reaction. [1],[3] Recurrence of hydatid cyst as in the present case has been attributed to rupture of the cyst during first surgery. [1],[3] Our patient was symptom-free during the follow-up period of three years.


   Acknowledgment Top


The authors are grateful to Dr. S. Kumar, Principal, M. S. Ramaiah Medical College, for his kind support for publishing this paper.

 
   References Top

1.Gupta S, Desai K, Goel A. Intracranial hydatid cyst: A report of five cases and review of literature. Neurol India 1999;47:214-7.  Back to cited text no. 1  [PUBMED]  Medknow Journal  
2.Trivedi A, Shukla S, Singh. K, Sharma V. Giant intracranial hydatid cyst. J Pediatr NeuroSci 2007;2:72-4.  Back to cited text no. 2      
3.Shukla S, Trivedi A, Singh K, Sharma V. Craniospinal hydatidosis: Report of three cases. J Pediatr NeuroSci 2008;3:146-9.  Back to cited text no. 3    Medknow Journal  
4.Ravalgi M, Kumar S, Shah AK, Vaghela DU, Makwana GJ, Singh K. CT and MRI features of the typical and atypical intracranial hydatid cysts: Report of 5 cases. Ind J Radiol Imag 2006;16:4:727-32.  Back to cited text no. 4      
5.Beskonakli E, Solaroglu I, Tun K, Albayrak L. Primary intracranial hydatid cyst in the interpeduncular cistern. Acta Neurochir (Wien) 2005;147:781-3.  Back to cited text no. 5      
6.Rumana M, Mahadevan A, Nayil Khurshid M, Kovoor JM, Yasha TC, Santosh V, et al. Cestode parasitic infestation: Intracranial and spinal hydatid disease - A clinicopathological study of 29 cases from South India. Clin Neuropathol 2006;25:98-104.  Back to cited text no. 6      

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Correspondence Address:
Sulata M Kamath
38, 18th Cross Road, Malleswaram West, Bangalore - 560 055
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DOI: 10.4103/0377-4929.56159

PMID: 19805978

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
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