Multiple organ involvement with hydatid cysts

Hydatid disease is the most common infections worldwide, but it rarely involves multiple organs. Herein, a 12-year-old boy is presented, who was admitted to Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran with symptoms of irritability, sleepless, and weakness of the extremities. Patient's brain computed tomography [CT] scan with contrast media showed large multilocular cystic lesions in right temporal lobe associated with two other smaller similar cystic lesions in centrum semiovale bilaterally. Abdominal sonography revealed intestinal mesenteric and a cardiac cyst. Abdomino-pelvic CT scan showed a cyst medial to the cecum and a cortical cyst in the left kidney as well as a heart cyst. The echocardiography confirmed hydatid cysts at apical and interventricular septum. Serology test was positive for hydatid cyst. Albendazole and praziquantel were started for the patient immediately and right temporal lobe lesions were removed via neurosurgery intervention. After one month, cardiac and mesenteric cysts were operated during two separate surgeries. Pathologic findings of all cysts were compatible with hydatid cyst. Cystic hydatidosis should be suspected in any cystic mass, whilst prompt diagnosis and appropriate treatments are the keys in management of affected patients

Intracranial rhabdomyosarcoma presented as chronic subdural hematoma: a case report

Intracranial rhabdomyosarcoma is a very rare disorder. Subdural rhabdomyosarcoma has not been reported yet. It can be misdiagnosed with chronic subdural hematoma in CT images. Herein, we presented a 2.5-year-old boy with intractable chronic subdural hematoma who were treated with burr hole insertion, needle aspiration and shunting for about 2 years with partial resolution of his symptoms after each procedure. The final pathologic evaluation after extensive bilateral craniotomy revealed rhabdomyosarcoma. The role of CT and MRI in early diagnosis and management of this rare situation is discussed

Vanishing of a congenital intracranial aneurysm

Intracranial aneurysms in neonatal period and early infancy may be resorbed spontaneously or due to removal of predisposing factors. Herein, we presented a rare case of vanishing of a large thrombosed intracranial aneurysm in a 25-day-old girl presented with head enlargement and vomiting. Magnetic resonance imaging [MRI] revealed a severe hydrocephalus accompanied by a 1.5-cm aneurysm at the bifurcation of the right middle cerebral artery [MCA]. Doppler ultrasonography confirmed a flow with a magnitude almost similar to that of the right MCA flow, inside the mass located adjacent to it. The hydrocephalus was managed by ventriculo-peritoneal [VP] shunt. The patient underwent a conservative observation for several months. Subsequently, the aneurysm was vanished in control images

[Spinal subdural abscess: 4 cases report during ten years in Tehran Children Medical Center]

Bacterial abscesses involving the spinal canal are associated with a high morbidity and mortality. Most frequently, these lesions are found in the epidural, rarely in the subdural spaces. Spinal subdural abscess is rare. The exact incidence of the spinal subdural abscess [SSA] is unknown and the most affected region is the thoraco-lumbar spine. The timing for MRI is very important when the clinician notices these symptoms in the patient. Early diagnosis and emergent treatment is vital to prevent the formation or progression of neurologic deficits. Although the most common bacterial source is Staphylococcus aureus, bacterial sources were proteus and E.coli in the patients. In this report, we presented four patients with SSA in the thoraco lumbar region. Over the last 10 years, four cases of spinal subdural abscess were admitted and treated at Tehran Children Medical Center. All of four cases were under 3 years old and surgically and medical treated. All four patients were received antibiotics for a period of 4-6 weeks and showed remarkable recovery

[Comparison between ceftriaxone and co-trimoxazole in prevention of infection in cerebro-peritoneal shunt]

Shunt infection, a common problem in shunt-inserted patients, is an important concern in neurosurgery. It increases mortality rate and causes developmental and cognitive delay in children. Use of antibiotics and selection of them in preventing shunt infection is controversial. In this randomized clinical trial, we compare the effect of ceftriaxone and co-trimoxazole in this concern.We studied 85 hydrocephalous children hospitalized in Children's Medical Center [2003-2004]. Patients, aged 1 month to!2 years, were divided into two similar groups [according to age, sex, and etiology of hydrocephaly], received one of both antibiotics pre-op and followed up for possible infection for one year.Shunt infection occurred in 10 patients aged 2-36 months <6 months after surgery [80%]. We did not find any significant difference between the two antibiotics regarding infection prevention. The most effective factors in increasing shunt infection were low age of the patients and CSF leakage.According to the ineffectiveness of antibiotics in preventing shunt infection, it seems that the risk can be reduced by controlling other factors like better sanitation and less traffic in operating rooms, faster surgery and decreasing chance of CSF leakage