Teaching NeuroImages: Giant cystic echinococcosis with unusual imaging manifestations

A 6-year-old girl presented with a 3-month history of progressive left-eye strabismus and vision loss. MRI scan of the brain showed a single hypointense lesion in the left cerebral hemisphere with no perilesional edema or contrast enhancement (figure 1, A–C). At surgery, the lesion was shown to be a single large parasitic cyst measuring approximately 7.0 x 6.5 x 6.0 cm (figure 2, A–C). The patient underwent a complete resection and then was given antihelminthic therapy. This resulted in an uneventful recovery. Pathology confirmed a diagnosis of brain cyst with scolex. This imaging feature of giant cystic echinococcosis is very unusual.1 In the event of neurologic dysfunction or elevated intracranial pressure, emergent operative intervention should precede the administration of antihelminthic medications as the latter may weaken the cyst membrane and complicate resection. Gross total resection has advantages compared with nonsurgical treatment with antihelminthics.2

Source: Neurology - June 5, 2017 Category: Neurology Authors: Nie, D., Xia, L., Chen, J., Shi, W., Sun, G., Guo, J. Tags: Medical care, MRI, Parasitic infections, Post-infectious, Central pain RESIDENT AND FELLOW SECTION Source Type: research