Diagnosis, treatment, and misdiagnosis analysis of 28 cases of central nervous system echinococcosis

Abstract

Background: To explore central nervous system (CNS) involvement in this disease, from the perspectives of diagnosis, treatment, and misdiagnosis METHODS: Twenty-eight patients with CNS echinococcosis were included in this retrospective study, including 18 males (64.3%) and 10 (35.7%) females. The average age of all the patients were 23.5 years (ranged 4-60 years). Twenty-three (23) patients (82.1%) received the first surgical resection in our hospital. Five (5) patients (17.9%) gave up surgical treatment for multiple-organ hydatidosis and previous surgery history at other hospitals, and albendazole was applied for a long-term (3-6 months) adjunct therapy for the 5 patients. The average follow-up time was 8 years.

Results: For the 28 patients, 23 cases received surgical treatments, and the diagnosis was confirmed by pathological examinations. The diagnosis of 4 cases of brain echinococcosis and 2 cases of spinal cord echinococcosis could not be confirmed, resulting in a misdiagnosis rate of 21.4% (6/28). For the pathological examination, a total of 17 cases were infected with Echinococcus granulosus (including 2 cases of spinal cord echinococcosis), and 6 cases were infected with Echinococcus alveolaris.

Conclusion: The diagnosis should be specifically considered in endemic regions. The clinical features of CNS hydatidosis were intracranial space-occupying lesions. For the treatment, the surgical removal of cysts should be necessary. In addition, the adjuvant therapy with drug and intraoperative prophylaxis is also suggested. The misdiagnosis may have resulted from atypical clinical features and radiographic manifestations, as well as the accuracy of hydatid immunologic test.

Keywords: Central nervous system; Diagnosis; Echinococcosis; Treatment.

Fig. 1

Brain Echinococcus granulosus. a CT scan revealing a solitary cystic lesion located in the right frontotemporal lobe. The margins are well delineated. The intralesional fluid displays the same attenuation value as that of CSF. There is no obviously perilesional edema. b CT scan shows multiple cystic lesions in frontoparietal lobe, with the same density as CSF. c MRI T1-weighted images shows a homogeneous, thin-walled cystic lesion (yellow arrows). There is significant mass effect on the lateral ventricular system. Midline shift is 2 cm. Cyst signal is isointense relative to CSF. d MRI shows a cystic lesion hyperintense on T2-weighted images (similar to CSF) with a hypointense halo around the cyst capsule (yellow arrow). e Dowlings technique. f Photomicrography (HE, original magnification, 400) shows Echinococcus granulosus infection of the brain

Fig. 2

Brain Echinococcus alveolaris. a CT scan shows a mixed density solid lesion located in the right temporal lobe. There is slight perilesional edema. b MRI T1W axial MR image shows multiple equal T1 signal intensity lesion located in frontoparietal lobe. There is obviously perilesional edema. c MRI T2W axial MR image shows a short T2 signal intensity multiple lesions with obviously perilesional edema located in the same place. d Contrast-enhanced MR image shows obvious enhancement of the lesion wall (yellow arrows). e Photomicrography (HE, original magnification, 400) shows Echinococcus alveolaris infection of the brain