Cauda Equina Syndrome Caused by Primary Lumbosacral and Pelvic Hydatid Cyst: A Case Report

Abstract

Introduction: Hydatid disease occurs in humans as a result of faeco-oral contamination and spinal echinococcosis is rare even in areas where echinococcosis is endemic. Hydatid cyst primarily occurs in the liver and lungs. Bone involvement constitutes only 0.5-2% of all hydatidoses. About half of the bone involvement occurs in vertebrae. The thoracic spine is the most common site of the spinal hydatidosis. Primary hydatid cysts of the lumbar and sacral spinal canal are very rare.

Case Report: We present a 31-year-old man with cauda equina syndrome caused by a primary hydatid cyst of the lumbosacral and pelvic areas. He had been admitted to hospital with left foot and low back pain three years ago. Magnetic resonance imaging revealed an intraspinal hydatid cyst extending from L2 to S2. The cyst had been totally removed. He was symptom-free for three years. After three years, he presented with acute cauda equina syndrome. His neurological examination revealed total plegia of dorsal flexion of the left foot and perianal hypoaesthesia. MRI showed lumbosacral and pelvic hydatidosis again. After total removal of the cyst, his neurological status revealed immediately relief.

Discussion: Hydatid cyst is an important health problem in some countries including Turkey. Bone involvement is seen in only 0.5-2% of cases. Furthermore sacral and lumber vertebral involvement is extremely rare. We presented a case with a spinal hydatid cyst which classified as a combination of intraspinal extradural, vertebral and paravertebral forms according to the Braitwate and Lees classification. Surgical excision and additional medical treatment is still the most effective treatment. Cysts located intraspinally have a tendency to rupture spontaneously. For this reason the high recurrence rate (30- 40%) is still a major problem in management.

Key words

hydatid cyst - cauda equina - lumbosacral

References

• 1 Pamir MN, Akalan N, Özgen T, Erbengi A. Spinal hydatid cyst.  Surg Neurol. 1984;  21 53-57
• 2 Rayport M, Wisoff HS, Ziman H. Vertebral echinocossosis.  J Neurosurg. 1964;  21 647-659
• 3 Braithwaite PA, Lees RF. Vertebral hydatid disease. Radiological assessment.  Radiology. 1981;  140 763-766
• 4 Kautzanis M, Anagnostopoulos D, Apostolou A. Hydatid disease affecting the vertebra.  Acta Neurochir. 1989;  89 60-65
• 5 Islekel S, Ersžahin Y, Zileli M. et al . Spinal hydatid disease.  Spinal Cord. 1998;  36 166-170
• 6 Pamir N, Özdamar K, Elmaci İ İ. Spinal hydatid disease.  Spinal Cord. 2002;  40 153-160
• 7 Singh RS, Sahay S. Retroperitoneal primary hydatid cyst of pelvis.  J Indian Med Assoc. 1985;  83 64-65
• 8 Stern W, Stern WE. Parasitic infestations. In: Wilkins RN, Rengachary SS (eds). Neurosurgery. Mc Graw Hill, New York 1985: 2010-2015
• 9 Sapkas GS, Stathakopulos DP, Basis GC. et al . Hydatid disease of bone and joints.  Acta Orthop Scand. 1998;  69 89-94
• 10 Lam KS, Faraj A, Mulholland RC. et al . Medical decompression of vertebral hydatidosis.  Spine. 1997;  22 2050-2055
• 11 Sucu K, Zileli M. Omurga ve omurilik enfeksiyonları. In: Zileli M, Özer AF (eds). Omurilik ve omurga cerrahisi. Cilt 2, İIzmir 2002: 1150-1154
• 12 Singh S, Korah IP, Gibikote SV. et al . Sacral hydatidosis: value of MRI in the diagnosis.  Skeletal Radiol. 1998;  27 518-521
• 13 Fahl M, Haddad FS, Habullah M. et al . Magnetic resonance imaging in intradural and extradural spinal echinococcosis.  Clin Imaging. 1994;  18 179-184
• 14 Garg M, Chavla S, Prasad KN. et al . Differentiation of hydatid cyst from cysticersus cyst by proton MR spectroscopy.  NMR Biomed. 2002;  15 320-326
• 15 Carey M. Infections of the spine and spinal cord. In: Youmans JR (ed). Neurological Surgery. 4th edn, WB Saunders Comp, Philadelphia 1997
• 16 Tekkök IH, Benli K. Primary spinal extradural hydatid disease. Report of a case with MR characteristics and pathological correlation.  Neurosurgery. 1993;  33 320-323
• 17 Turtas S, Sehrbundt V, Pau A. Long term results of surgery for hydatid disease of the spine.  Surg Neurol. 1980;  13 468-470

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