Cerebral hydatid disease with serpent sign, calcifications, and peripheral enhancement
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Cerebral hydatid disease with serpent sign, calcifications, and peripheral enhancement Mustafa Kemal Demir1 · Özlem Yapıcıer2 · Muslim Ageel Jameel3 · Mustafa Bozbuğa4 Received: 4 January 2019 / Accepted: 22 February 2019 © Belgian Neurological Society 2019
A 44-year-old male with an unremarkable medical history was admitted to the hospital with episodes of headache in the left frontal region for 6 months. Magnetic resonance (MR) imaging of the brain was performed and revealed a mass in the left frontal lobe. The lesion demonstrated high-signalintensity matrix associated with curvilinear low-signalintensity regions on T2-weighted images and hypointense heterogeneous signals on T1-weighted images. The capsular wall of the lesion was isointense on T1-weighted images and hypointense on T2-weighted images. It revealed enhancement on postcontrast T1-weighted imaging, whereas the internal matrix did not enhance. Susceptibility-weighted imaging (SWI) demonstrated hypointense signal intensity areas in the lesion. The mass was completely hypointense on diffusion weighted image (DWI) (Fig. 1). A CT image of the thorax and abdomen was performed for screening but was normal. Surgery was performed. The mass was completely resected. No postoperative complications were noted, and the patient was discharged in good general condition. * Mustafa Kemal Demir [email protected] Özlem Yapıcıer [email protected] Muslim Ageel Jameel [email protected] Mustafa Bozbuğa [email protected] 1
Department of Radiology, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, 11. kisim, Yasemin Apt, D blok. Daire 35 Ataköy, 34158 Istanbul, Turkey
2
Department of Pathology, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, Istanbul, Turkey
3
Bahçeşehir University School of Medicine, Istanbul, Turkey
4
Department of Neurosurgery, Üsküdar University NPİstanbul Brain Hospital, Istanbul, Turkey
Histopathologic examination of the specimen demonstrated the outer layer of hydatid cyst wall consisting of variable inflammatory cells with sharp demarcation from the adjacent brain parenchyma. The PAS (periodic acid–Schiff) positive middle layer of the cyst wall was avascular, eosinophilic and laminated. There were calcified protoscolices within the disrupted brood capsule (Fig. 2). He was stable and wellimproved in the follow-up period. Echinococcosis or hydatid disease, is a general term defining the zoonosis caused by Echinococcus tapeworms, or cestodes. Primary cerebral hydatid disease is rare. It constitutes less than 2% of all echinococcosis cysts reports. It may result as a consequence of a traumatic, or surgical rupture of a solitary primary cyst found elsewhere in the body which leads to the mobilization of hydatid scolices to the brain. However, it may also arise in the brain itself. It can be located in any area of the brain, but it is most commonly seen at the area supplied by the middle cerebral artery in both c
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