Surgical Neurology International

Background:Echinococcus multilocularis is a rare infestation in the world with a particularly increased incidence mainly in South America, Central Europe and Asia. Progression of alveolar Echinococcosis is more aggressive that can metastasize to lungs, brain and bones however brain involvement is usually rare with an incidence about 1%.

Case Description::We report a 23-year-old man with a cerebellar Echinococcosis multilocularis mimicking a metastatic cerebellar tumor. Suboccipital craniotomy was performed for gross total removal of the tumor. Histopathological specimens confirmed the diagnosis of Echinococcosis multilocularis.

Conclusion:Radical surgical excision should be recommended for single Echinococcosis multilocularis lesions particularly at infratentorial localization.

Keywords:Alveolar hydatid cysts, cerebellum, echinococcus, surgery, tumor

INTRODUCTIONHydatid disease is a parasitic infestation produced by Echinococcus granulosus (EG) and Echinococcus multilocularis (EM).[3] EM is a rare human infestation with a wide geographic distribution especially in regions like South America, Central Europe, Central and East Asia.[8,10] Echinococcosis is endemic for Turkey, particularly in Eastern and Northeastern Anatolian region.[2] The life cycle is completed when a fox or canine consumes a rodent that is infected with cysts. Human beings can be the accidental host for these parasites.[11] EM primarily affects the liver. This chronic infestation may spread hematogenously to produce metastatic foci in the distant organs. Involvement of the brain is rare, reported to be around 1%.[7,13] Alveolar hydatid cysts constitute 3% of cerebral hydatid cyst cases. Infratentorial involvement is considerably rare.[4] Here we report a 23-year-old man with cerebellar involvement of Echinococus multilocularis mimicking a metastatic cerebellar tumor.

CASE REPORT:A 23-year-old man presented with nausea, imbalance,occasional urinary and fecal incontinence and a severe headache for 1 month. The patient was a farmer with an unremarkable past experience for his relatives. Neurological examination was completely normal. Magnetic resonance imaging (MRI) demonstrated a left cerebellar mass lesion of 3×2×1.5 cm in size with marked peripheral contrast enhancement [Figure 1]. Computed tomography (CT) examination of the chest and abdomen were performed for a primary origin. Multiple calcified mass lesions with lobulated contours were shown in the right upper lobe of lung, right liver and another solid tumor between right kidney and liver. Suboccipital craniotomy was performed and a left intracerebellar pale yellow mass was excised grossly as total. The tumor was almost avascular and it was easily dissected from the surrounding cerebellar tissues. Postoperative course was unremarkable without any neurological deficit. Histopathological examination revealed PAS (+) cuticular membrane with wide areas of necrosis and inflammation which were typical for EM [Figure 2]. Serological tests at the postoperative period confirmed the presence of EM with indirect hemagglutination test. Albendazole (800 mg, bid, 3 cure, 28-day cycle followed by a 14-day albendazole-free interval) and cephotaxime (4 g, bid) were prescribed for postoperative treatment. A further operation was performed to resect the lesion in the lung a month after intracranial surgery. Postoperative early CT examination and MRI performed 6 months after surgery showed no recurrence.

Bulgular:İnkübe edilen 45 adet embriyonun 41’inde nöral tüpün kapalı olduğu ve embriyonun normal gelişim gösterdiği görüldü.

SONUÇ:Levetirasetam’ın insan tedavi dozuna eşdeğer dozda ve bu değerin 10 katı yükseklikte verilen dozlarda civciv embriyosunda nöral tüp defekti oluşturmadığı gözlemlenmiştir.

Anahtar Sözcükler:Levetirasetam, Civciv embriyosu, Nöral tüp defekti