LAUSR

DOI https://doi.org/ 10.1055/s-0039-1695700 ISSN 0976-3147. ©2019 Association for Helping Neurosurgical Sick People Hydatid disease is caused by the larval form of Echinococcus granulosus. The reported occurrence of bony hydatidosis is 0.5 to 3% of all the cases and 50% of this affects the spine. Spinal echinococcal cyst accounts for 1% of all cases of hydatid disease. The thoracic spine is most commonly involved followed by the lumbar and then the sacral.1,2 We report a 21-year-old female who presented with nonhealing ulcer in the right leg, gradually progressing back pain radiating to both lower limbs, paraparesis, and urinary complaints, such as urgency and frequency, for a duration of 3 months. She hailed from rural Eastern India and belonged to low socioeconomic strata. She had a history of contact with sheep and cattle. She had no history of any chronic medical illness. There were no hydatid cysts in any other sites in her body, like lung and liver. Clinical examination revealed local tenderness at the lower lumbosacral region. No soft tissue swelling was appreciated.Neurological evaluation showed lower motor neuron type paraparesis. There was diminished sensation below L5 on both sides, and both the lower limbs had power two-fifths. The knee and ankle jerks were absent and plantars were not elicited. Magnetic resonance imaging (MRI) showed a large expansile lesion of size 7.8 cm × 7.0 cm × 6 cm with pathologic fracture and collapse of S1 vertebra. The lesion showed centrally clumped T2 and T1 hypointense curvilinear membranes with peripherally arranged T2 hyperintense daughter cysts (►Fig. 1A, B). The lesion was bulging into prevertebral, bilateral paravertebral, epidural (extending from L5 to S2 vertebral levels), and bilateral neural foraminal locations compressing the cauda equina and exiting nerve roots. The posterior surfaces of L5 to S2 vertebrae were scalloped suggesting its long-standing nature. The adjoining intervertebral disc spaces were relatively preserved. These MRI features were characteristic of spinal hydatid disease. J Neurosci Rural Pract 2019;10:565–566