Intra parenchymal neuroglial versus Hydatid cyst (MR).

PROTOCOL:

T1W – Sagittal & axial scans
T2W – Axial & coronal scans
FLAIR – Axial scans

FINDINGS:

-Evidence of a big intra axial cystic structure is noted in the left hemisphere of the brain occupying left fronto-parietal and occipital regions with multiple septation and loculation at its posterior portion. It measures about 75 x 68 x 53 mm in diameters (AP& height& transverse respectively) causing marked shift of the mid line structures to the contra lateral side (24 mm) with compression of the left lateral ventricle and dilatation of the right lateral ventricle.
-The brain stem including mid brain and pons show also shift to the right side and to less extent cerebellum; yet no definite evidence of tonsillar herniation could be suggested at the time of this study.
-Small sized fourth ventricle and posterior fossa.
-It shows intensity respective to that of the CSF with no definite surrounding edema or gliosis and no connection to the ventricle.
-No evidence of abnormal enhancement could be noted.
-Cortical sulci in the ipsilateral side are effaced.

-The rest of the brain Parenchyma shows normal grey white matter differentiation and signal intensities.  No focal mass lesion is seen.
-Brain stem and cerebellum show normal signal intensities.

OPINION:

• Picture is suggestive of an intra axial big left cerebral cyst.
• Differential diagnosis is neuroglial cyst versus hydatid one.