HYDATID CYST OF THE BRAIN

was inc luded in a s t u d y of the ecology of h y d a t idosis in t he N o r t h w e s t by R a u s e h and Schiller25 A n o t h e r i n s t ance of cerebral h y d a t i d cyst is p re sen ted here. P reopera t ive ly , i t was er roneous ly d iagnosed as a n avascu l a r neoplasm on the basis of ca ro t id ang iog raphy . A grea te r awareness of the poss ib i l i ty of echinococcosis m i g h t have led to a b e t t e r p l a n n e d opera t ive app roach wi th conseq u e n t avo idance of r u p t u r e of the cyst and spilling of i ts con ten t s . T h e cyst was, however, successfully resected a n d the p a t i e n t has re tu rned to her usual act iv i t ies . Received for publicaticn Novemher 16, 1964. Case R e p o r t Mrs. D.A. (Los Angeles County General Hospital PF#293-34-49) was born in Mexico in 1910. Except for a month-long visit to her birthplace in 1957, she had lived in Los Angeles since 199~. In March 1961 her right arm suddenly became weak and speech was noted to be slurred. This disturbance cleared within 3 days. The patient made a brief stay at a psychiatric hospital where a diagnosis of involutional depression was recorded. Similar episodes recurred twice during tile next 18 months. Beginning in August, 1969, the right upper and lower extremities became progressively weaker. The paresis was accompanied by right parieto-occipital headaches. Her right arm was burned in September, 1969, but no pain was experienced. Repeated questioning of the patient and her family failed to reveal any history of related prior illness. She had been pregnant 3 times and delivered without complications in 1930, 1936 and 1946. Examination. V~llen seen at the Los Angeles General Hospital on October s 1969, she seemed a well-developed and well-nourished woman with a blood pressure of 180/80, and a pulse of 80. The left parietooccipital region of the skull was tender but no exostoses were palpable nor were any bruits audible. The pat ient was oriented as to person and place but not as to time. Although bilingual, she had considerable trouble with word selection even in Spanish. There was equivocal blurring of the temporal margins of both optic discs. Right homonymous hemianopia was demonstrated by confrontation testing. There was hypalgesia in the right trigeminal distribution. The right lower facial muscles were weak. Paresis was also demonstrated in the right arm and to a lesser extent in the right leg. There was apraxia in the right hand. Sensory examination revealed right hemihypalgesia and hypesthesia as well as extinction of simultaneously applied tactile stinmli on the right side. Proprioceptive and vibratory sensibilities were diminished in the right leg. There were hyperactive tendon reflexes on the right side, normal abdominal reflexes and upgoing plantar responses bilaterally. Laboratory examination. The hemoglobin was 14 gm. and urinalysis was normal. The lumbar eerebrospinal fluid pressure was 900 ram. of water. The fluid was clear, colorless and without cells; protein content was 53 mg. per cent, sugar 61 mg. per cent and chloride 191 mg. per cent. Raentgenogram of the chest was normal. Bilateral carotid arteriography revealed an avascular left frontal opercular and parietal lesion with a square shift of the anterior cerebral and pericallosal arteries to the right as well as a shift of the internal cerebral vein (Fig. la, b). Operation. On October 27, 1969, a left parietotemporal