title: Calcified Mass on Brain CT in a Teenager with Refractory Seizures.
abstract: Cerebral echinococcosis is very rare, representing 2% of all cystic echinococcosis (CE) cases. Primary echinococcal cysts of the brain are extremely rare in pediatric patients. We report on a 16-year-old boy referred to our tertiary center with intractable epilepsy for the previous three years despite receiving full doses of three antiepileptic medications. Brain computed tomography (CT) showed a left frontal calcified mass. Magnetic resonance imaging (MRI) of the brain revealed a well-defined spherical mass in the left frontal lobe, slightly hypointense on T1-weighted and heterogeneous hyperintense on T2-weighted images with no contrast enhancement. With a broad differential list in mind, a surgical intervention was planned. During surgery, a primary calcified cerebral echinococcal cyst with severe adhesion to the adjacent dura of the frontal region was discovered and removed intact. Histopathology examination confirmed the diagnosis. Only phenobarbital was continued and no medical therapy for CE was administered. Two years after surgery, the patient remained free of seizures. In areas endemic for CE, cerebral echinococcal cyst should be included in the differential list of patients with intractable seizures. Though rare, this entity can present itself as a calcified mass on neuroimaging. Surgical removal of the calcified cyst is necessary for control and treatment of the epilepsy.
authors.affiliation: Department of Neurosurgery, Arad Hospital; Tehran, Iran - mrkhalatbari@hotmail.com.
authors.forename: Mahmoud Reza
authors.initials: MR
authors.lastname: Khalatbari
authors.affiliation: Division of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, University of Pavia, WHO Collaborating Centre for the Clinical Management of Cystic Echinococcosis; Pavia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Brunetti
authors.affiliation: Radiology Department, Kermanshah University of Medical Sciences; Kermanshah, Iran.
authors.forename: Elham
authors.initials: E
authors.lastname: Shobeiri
authors.affiliation: Department of Neurosurgery, Arad Hospital; Tehran, Iran.
authors.forename: Yashar
authors.initials: Y
authors.lastname: Moharamzad
mesh_terms: D000293:Adolescent; D001927:Brain Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D003399:Craniotomy; D004443:Echinococcosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D005625:Frontal Lobe / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging / Q000379:methods; D012640:Seizures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Echinococcus; adolescent; calcified hydatid cyst; cerebral calcification; cerebral hydatid cyst; refractory seizures