Spinal Hydatid Disease with Neurologic Complications: A Report of Two Cases and Review of Literatures

Case Presentation

Austin Emerg Med. 2016; 2(9): 1048.

Spinal Hydatid Disease with Neurologic Complications: A Report of Two Cases and Review of Literatures

Meshkini A1, Bazzazi AM2, Mirzaei F1, Javanshir N3 and Naseri Alavi SA1*

¹Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

²Department of Neurosurgery, Tabriz Aalinasab Hospital, Tabriz, Iran

³Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

*Corresponding author: Seyed Ahmad Naseri Alavi, Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

Received: December 17, 2016; Accepted: December 29, 2016; Published: December 30, 2016


We present two patients with spinal hydatid disease who presented with its consequent neurologic complications. The first was a 32-year-old female with sudden urinary retention, paraparesis, low back pain and decreased libido. Magnetic resonance imaging revealed a solitary mixed lobulated mass in the right paravertebral region at T6-T7 level. She underwent surgical decompression and appropriate chemotherapy. Although the symptoms were relieved, she came back after 56 months with recurrence of the disease. The second case was a 12-year-old boy presented with weakness in the lower limb and upper motor deficit. On magnetic resonance images, there was a solitary anteriorly located intramedullary mass at T1-T2. During surgical excision, an intradural extramedullary cystic mass was found. Surgical excision and decompression was performed and oral albendazole was administered. The symptoms resolved and the patient was stable within three years follow-up.

Keywords: Hydatid Cyst; Thoracic Spine; Case Report; Neurologic Complication


Hydatid disease (cystic echinococcosis, hydatidosis), which is caused by two larval forms of Echinococcus, E. granulosus and less commonly E. multilocularis [1], is one of the most prevalent helminthic infections all over the world and is endemic in Iran and in its neighbor countries [2,3]. Bone involvement is not a very common finding in hydatid disease (0.5 to 4%), with spinal involvement in about half of these cases [4-6]. However, spinal hydatid disease is always in the list of differential diagnoses in patients with paraparesis, paralysis and pain in the spinal region in endemic areas [7]. Spinal involvement can be morphologically classified into five types: 1) primary intramedullary hydatid cysts; 2) intradural extramedullary hydatid cysts; 3) extradural intraspinal hydatid cysts; 4) vertebral hydatidosis; and 5) paravertebral hydatidosis [8]. Operative procedures are the method of choice, especially in symptomatic patients with the cord compression; usually accompanied with adjuvant chemotherapy [9]. Despite this aggressive approach, the recurrence rate is still discouragingly high [10]. The authors report histopathologically confirmed spinal hydatid disease in two cases presented with neurological complications.

Case Presentation

Case 1

The first case with spinal hydatid disease was a 32 year-old married female who presented with sudden urinary retention to the department of emergency at Imam Reza Teaching Centre, Tabriz, Iran. She had experienced off and on but increasing paraparesis and pain in her lumbar region, as well as a progressive impairment of libido for the last 3 months before development of urinary retention. In physical examination, muscle strength of both lower extremities was decreased; 3/5 and 2/5 at proximal and distal part of the left lower limb, and 2/5 and 1/5 at proximal and distal part of the right lower limb, respectively. Deep tendon reflexes (DTRs) were increased at both sides of the lower limb (4+), while the Babinski’s reflex was normal. Muscle wasting was prominent in the lower extremities. Clonus was detected in the right side. The patient was investigated with routine hematologic investigations including blood counts, and underwent abdominal ultrasonographic examination with inconclusive findings. Plain radiographs of the spine in anteroposterior (AP) and lateral views revealed presence of a mass at the level of thoracic spine. On these plain radiographs, there was a well-defined osteolytic cavitatory area without periosteal reaction or sclerosis. A computerized tomography (CT) scan showed presence of a massive destructive effect on the posterior ring and right pedicle of the T6 vertebrae, along with osteolysis in its transverse process and adjacent ribs (Figure 1). Magnetic resonance (MR) images presented a solitary mixed lobulated space occupying lesion in the right paravertebral region at T6-T7 level, suggesting of hydatid cyst. The patient was administered oral albendazole (400mg TDS) and the mass was excised surgically. A laminectomy was performed through the posterior approach for decompression. A histopathologic confirmation of the diagnosis was obtained. The antihelminthic therapy was continued for 1 year. Follow-up program including regular neurologic assessment plus imaging investigations was carried out every 4 weeks. The patient was lost to follow-up after 12 months postoperation. Within this period, no abnormal finding was documented; however after 56 months from the first operation, the patient was admitted again for recurrence of the disease. The chief complaint for new admission was a progressive paraparesis in the lower limbs developed within 1.5 months. The patient was not able to walk before being seen at our department. The main finding on new CT scan and MRI was presence of a cystic mass in the right neuroforamen at level of T4-T5 with a right paravertebral and epidural component (Figure 2). The lesion was hyposignal on T1W and hypersignal on T2W images. After excision, the histopathological examination confirmed recurrence of the disease.

Citation: Meshkini A, Bazzazi AM, Mirzaei F, Javanshir N and Naseri Alavi SA. Spinal Hydatid Disease with Neurologic Complications: A Report of Two Cases and Review of Literatures. Austin Emerg Med. 2016; 2(9): 1048. ISSN : 2473-0653