Presentation of Echinococcal Infections of the Central Nervous System in Children

Symptoms

Clinical findings are related to the site and size of the lesions (4, 10, 12, 23, 28).

• Mental changes: Altered mental status is noted in 25% of children with hydatid cysts in the CNS.
• Seizure: Epileptic activity is seen in approximately 20% of affected individuals.
• Increased ICP: Signs of elevated ICP including headache, vomiting and papilledema are usually present in patients with intracranial hydatid cyst at the time of diagnosis.
• Other symptoms of CNS dysfunction: Other symptoms, such as hemiparesis, visual field alteration, and gait disorders, may be present depending on the location of the cyst (32, 39).

Patterns of evolution

• Symptoms reflect location: Cerebral hydatid cysts are benign, slowly growing cysts. The cysts present with different clinical findings depending on the involvement of intracranial structures.

Time for evolution

• Cysts grow at rate of 0.7–1 cm/month: In several studies, the growth rate of the diameter of the hydatid cysts has been reported to vary from 7 mm/month by Altinors et al. (1) to 1 cm/month over a 6-month period by Evliyaoglu and Keskil (21). Sierra et al. reported a growth rate of 5 cm/year in a patient with secondary cysts (42). The lesions may remain asymptomatic until they are quite large.

Intervention

Stabilization

• Increased ICP: Not uncommonly, patients present with signs of increased ICP that require standard measures of management.
• Seizures: Children with hydatid disease who present with seizures require acute intervention to manage the seizures.

Preparation for definitive intervention, nonemergent

• Preparation for surgical management: Although rare, a hydatid cyst may rupture spontaneously. Thus, the child should be prepared for surgical removal of the cyst as soon as possible (1, 9).

Preparation for definitive intervention, emergent

• Rupture of cyst requires emergency surgery: A child with a diagnosed hydatid cyst may present with signs of cyst rupture such as deteriorated consciousness or hemiparesia. In such a case emergent hospitalization and preparation for surgery are required.

Admission Orders

• Routine