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Presentation of Echinococcal Infections of the Central Nervous System in Children

This page was last updated on May 10th, 2017

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

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