Image in Hydatid Disease of the Central Nervous System.

Hydatid disease most frequently occurs in the liver. This article presents a case of spinal cord compression caused by vertebral hydatidosis with typical imaging characteristics and pathologic findings, which is rarely involved in the hydatidosis. The patient was successfully treated with surgical excision combined with antiparasitic therapy.

Unusual sites of hydatid disease: report of two cases of dumbbell formations.

Hydatidosis is a zoonosis caused by Echinococcus granulosus. Humans are accidentally contaminated by ingesting the parasite´s eggs mainly released through the faeces from infected dogs. Hydatidosis affects the bone in 0.5 to 2% of cases, with 44% of these cases involving in the spine. Vertebral hydatidosis is rare and it represents the most frequent and most dangerous form of bone involvement. This manifestation is extremely delicate, difficult to correctly identify and manage. The authors report two cases of vertebral hydatidosis revealed by medullar compression and increasing lumbar-radicular pain and functional impotence of lower limbs. Imaging showed multicystic bony lesions in lumbar spine. The extension into the spinal canal and to the perivertebral soft tissue were involved in both cases. We present those two cases to highlight the role of radiological exploration for diagnosis especially with magnetic resonance imaging (MRI) and the importance of monitoring this dangerous pathology.

[Horse tail syndrome revealing spinal-medullary hydatid disease]. / Syndrome de la queue de cheval révélant une hydatidose vertébro-médullaire.

Hydatid disease is an anthropozoonosis caused by the larval stages of the genus Echinoccus granulosus in humans. It mainly occurs in subjects living in the rural and livestock areas in the Mediterranean basin, South America, Near and Middle East. Spinal hydatid disease is rare but it is the most severe form of bone hydatid disease. It mostly affects the dorsal spine, increasing the risk of spinal injury; hence its severity. We here report the case of a 60-year-old female patient admitted with progressive bilateral, poorly systematized, paralyzing lumbar radiculopathy associated with urinary urgency. MRI showed lumbar spinal hydatid disease infiltrating the intra and extra-ductal structures and compressing the roots of the horse tail. The patient underwent surgery through a posterior approach with favorable outcome.

Of Cestodes and Men: Surgical Treatment of a Spinal Hydatid Cyst.

BACKGROUND: The cestode Echinococcus granulosus causes hydatid disease. In addition to manifestations in the liver and lung, it can lead to cystic lesions in the spine. CASE DESCRIPTION: We report a 42-year-old male patient with primary hydatid disease in the eighth thoracic vertebra. The only clinical symptom was chronic back pain. Although laboratory findings were normal, imaging displayed lytic destruction that raised the suspicion of a metastatic disease. Diagnostics of the thoraces and abdomen did not reveal other pathologic abnormalities. Follow-up magnetic resonance imaging (MRI) depicted a progressive compression of the spinal cord and inhomogeneous structure in the fat-suppressed sequences. Because the Jamshidi biopsy was inconclusive, the tumor board recommended surgery. Dorsal decompression, spondylodesis of T6-T10, and vertebral column resection of T8 with complete cyst removal were performed. The resected vertebrae showed a mucous-like lesion with white granular tissue interfusing the whole vertebral body. A pathologic examination and enzyme-linked immunosorbent assay confirmed E. granulosus. Thus chemotherapy with albendazole was initiated. A follow-up MRI of the whole spine confirmed complete remission and found no additional resettlements. The patient's back pain was resolved without neurologic deficits. CONCLUSIONS: For lytic manifestations of the vertebral column, hydatid cysts should be considered a differential diagnosis in addition to malignant metastasis, tuberculosis, and osteomyelitis. Thorough surgical resection and strict follow-up are necessary.

Endless story of a spinal column hydatid cyst disease: A case report.

We describe a case of multifocal relapsing hydatid cyst following multilevel thoracic corpectomy and 360° instrumentation surgery. A 41-year-old male patient presented with cord compression and paraplegia due to a multiseptated cystic lesion at T10-11 level. The cyst was excised with a combined anterior and posterior approach and 360° stabilization was performed. The patient received albendazole for 1 year after the surgery. The patient presented with paraparesis 5 years after the surgery. Cystic lesions between C2-T1 and T10-11 were detected on the spinal MRI and the patient was operated with removal of the lesions on both levels and adjuvant local 20% hypertonic saline application. The patient received albendazole for the postoperative 6 months. After 3 months from the surgery, the patient's paraparesis recovered. There was no recurrence after 2 years from the last surgery.

Hints for control of infection in unique extrahepatic vertebral alveolar echinococcosis.

The prognosis of vertebral alveolar echinococcosis (AE) is poor. We report on the unique outcome of a patient with preexisting liver cirrhosis, in whom a diagnosis of vertebral AE was established on vertebral histopathology (D4 corporectomy in 2010 for paraplegia). Therapeutic drug monitoring of albendazole (ABZ) showed that a low dosage was appropriate. The patient recovered and ABZ withdrawal was decided in 2014, with no relapse 18 months later. In this patient, infection was purely or mainly localized in the dorsal spine, and this may have been favored by liver cirrhosis. A longer follow-up is, however, needed to confirm cure.

A Rare Parasitic Infection: Primary Intradural Extramedullary Hydatid Cyst.

Echinococcus granulosus infrequently induces spinal hydatid cysts, and intradural hydatid cysts are extremely rare among these spinal hydatid cysts. We report a 30-year-old man with a history of progressive back pain caused by a previous back injury. Magnetic resonance imaging revealed a spinal intradural cystic lesion. After surgical removal, histopathological diagnosis was a hydatid cyst. The patient had no other symptoms of systemic hydatid cyst disease. Diagnosis of hydatid cyst should be considered prior to surgery, especially in young patients with spinal intradural cystic lesions, as leakage of the hydatid cyst's fluid during surgery is a frequent case of recurrence.

A rare and unexpected clinical progress and location on a primary extradural spinal hydatid cyst in a pediatric patient: a case report.

BACKGROUND: Involvement of spine in patients with hydatid disease (HD) is less than 1% and primary intra-spinal extradural HD is extremely rare. Although this disease is introduced as benign pathology according to its clinical presentation and biological behavior, intraoperative rupture of the cyst may aggravate the patients' outcome in the long-term especially in pediatric patient population. CASE PRESENTATION: We report a 9-year-old girl who presented a progressive neurological deterioration due to an enlargement of a ventrally located extradural hydatid cyst within the thoracic spinal canal. Total removal of the cyst was achieved by preserving the capsule integrity for preventing potential seeding. Our preoperative initial diagnosis based on the radiological findings was confirmed as cyst hydatid histopathologically. CONCLUSION: Cyst hydatid should be considered in the differential diagnosis of the presence of homogenous cystic lesions with regular shape inside the spinal canal especially in patients from endemic region. To our knowledge, this pediatric patient is the first case of cyst hydatid located ventral side of the spinal cord extradurally located inside the spinal canal showing no extension.

Hidatidosis vertebral: a propósito de un caso / Vertebral hydatidosis: case report

La hidatidosis causada por el echinococcus granulosus puede afectar cualquier órgano del cuerpo siendo el pulmón y el hígado los más comúnmente afectados. El compromiso vertebral por el echinococcus granulosus es de escasa prevalencia, comprendiendo con menos de 1% del compromiso óseo. Presentamos el caso de una mujer de 50 años que consultó en Servicio de Traumatología por cuadro de dolor lumbar progresivo, de cinco meses de evolución, irradiado a extremidad inferior derecha y posterior compromiso neurológico de extremidad. El estudio imagenológico reveló espondilodiscitis T12-L1 que posterior a estudio de biopsia confirmó este cuadro. El tratamiento es mixto, tanto ortopédico como quirúrgico. El nivel de recurrencia es alto, reportándose entre 30 y 40%. El objetivo de este caso es proponer diagnóstico diferencial de masa vertebral de origen desconocido y detallar el manejo de esta patología.

Hydatidosis caused by echinococcus granulosus may affect any organ in the body, with the lungs and the liver as the most commonly affected organs. Vertebral compromise resulting from echinococcus granulosus has a low prevalence and accounts for less than 1% of bone compromise. We report the case of a 50 year-old female who presented at the Trauma Service with progressive low back pain with 5 months of duration that irradiated to the right lower limb, and led to neurologic compromise of the limb. Imaging studies showed spondylodiscitis at T12-L1, confirmed by a biopsy. Treatment of this condition is both orthopedic and surgical. The recurrence rate is high, between 30 and 40%. The objective of describing this case is to propose the differential diagnosis of a vertebral mass of unknown origin and provide details as to how to manage this condition.

[Vertebral hydatidosis: case report]. / Hidatidosis vertebral: a propósito de un caso.

Hydatidosis caused by echinococcus granulosus may affect any organ in the body, with the lungs and the liver as the most commonly affected organs. Vertebral compromise resulting from echinococcus granulosus has a low prevalence and accounts for less than 1% of bone compromise. We report the case of a 50 year-old female who presented at the Trauma Service with progressive low back pain with 5 months of duration that irradiated to the right lower limb, and led to neurologic compromise of the limb. Imaging studies showed spondylodiscitis at T12-L1, confirmed by a biopsy. Treatment of this condition is both orthopedic and surgical. The recurrence rate is high, between 30 and 40%. The objective of describing this case is to propose the differential diagnosis of a vertebral mass of unknown origin and provide details as to how to manage this condition.

Imaging features of cerebral and spinal cystic echinococcosis.

PURPOSE: The main objective of this study was to describe the characteristic imaging features of cerebral and spinal hydatid disease (HD) in magnetic resonance imaging (MRI) and computed tomography (CT) in order to provide more effective differential diagnoses in endemic regions. We also aimed to use MRI and CT to evaluate whether the World Health Organization's (WHO) new classification of hepatic cystic echinococcosis (CE) could be used in the classification of cerebral HD. MATERIALS AND METHODS: We retrospectively reviewed the CT and MR images of 30 patients who were diagnosed with cerebral and spinal HD between 1990 and 2014. The imaging findings were noted. All hydatid cysts were classified according to the WHO classification of hepatic CE, consisting of six types. RESULTS: The study group consisted of 49 CEs in 27 patients with cerebral HD and 12 CEs in three patients with spinal HD. Of the cysts, 14 were type CL (cystic lesion), 29 were type CE1, 11 were type CE2 and seven were type CE3. In other words, 54 cysts were in the active group and seven were in the transition group. Most of the cysts were type CL and CE1. CONCLUSIONS: Even though characteristic imaging features could be used in the differential diagnosis of HD, sometimes the differentiation of HD from other cystic lesions may be difficult. The use of WHO classification will provide standardisation of uniform treatment modality, as the treatment of HD, according to the stage of the disease, may be surgical or medical.

Epidural and para spinal thoracic hydatidosis presenting with progressive paraparesis and paraplegia: a case report.

We report a 16 year old male patient from rural Ethiopia with pathologically and intraoperatively proven thoracic para spinal and epidural hydatidosis, a very rare involvement, who presented with progresive both lower limb weakness, loss of pain, touch and properioception and double incontinence of two weeks prior to hospital admission. The pathological, radiological (MRI and plain x-ray) and the intra operative findings are briefly discussed with literature review.

Acute hydrocephalus caused by intraspinal neurocysticercosis: case report.

BACKGROUND: Intraspinal neurocysticercosis is an uncommon manifestation that may present as an isolated lesion. Furthermore, acute hydrocephalus caused by isolated intraspinal neurocysticercosis without concomitant cerebral involvement is extremely rare. CASE PRESENTATION: A 64-year-old man presented with a history of severe headache, an unsteady gait, and occasional urinary incontinence. Magnetic resonance imaging of the thoraco-lumbar spine revealed multiple, cystic, contrast-enhancing intraspinal lesions. A computed tomographic scan of the brain showed marked ventricular dilatation but no intraparenchymal lesions or intraventricular cysticercal lesions. This case of acute hydrocephalus was found to be caused by isolated intraspinal neurocysticercosis and was treated by ventriculoperitoneal shunt placement and surgical removal of the intraspinal lesions (which were histologically confirmed as neurocysticercosis), followed by administration of dexamethasone and albendazole. CONCLUSION: Isolated spinal neurocysticercosis should be considered in the differential diagnosis of acute hydrocephalus when no explanation is found in the brain, particularly in geographical regions endemic for cysticercosis.

[Osteolytic bone lesion: vertebral alveolar echinococcosis in a patient with splenectomy]. / Lésion ostéolytique chez une patiente splénectomisée : à propos d'un cas d'échinococcose alvéolaire vertébrale.

INTRODUCTION: Osteolytic lesions are not always related to malignancies. CASE REPORT: We report an 82-year-old woman suffering from subcostal pain. The patient underwent a splenectomy 40 years previously. CT-scan and MRI highlighted a calcified hepatic lesion associated with an osteolytic lesion of the L5 vertebra. Osteolytic and hepatic lesions were attributed to an alveolar echinococcosis based on positive serological assays. CONCLUSION: To our knowledge, this is the first report of an alveolar echinococcosis in a patient with splenectomy and secondary lesions. We suggest that the splenectomy could have promoted the parasite spreading to vertebra.

Intramedullary spinal neurocysticercosis treated successfully with medical therapy.

Neurocysticercosis caused by Taenia solium and is a common parasitic disease of the cental nervous system. It usually presents with seizures, headaches, progressively worsening focal neurologic symptoms, visual disturbances, loss of bladder control, etc. However, acute onset symptoms may also be seen. MRI scans can accurately diagnose spinal or cerebral lesions and is also helpful in monitoring progress while on treatment. Albendazole is currently the drug of choice along with steroids for medical management of neurocysticercosis. The case of intramedullary spinal neurocysticercosis was treated with praziquantel.