Primary Isolated Interventricular Hydatid Cyst With Left Ventricular Vegetation Presents With Neurological Manifestations: A Case Report

In areas where hydatid disease is endemic, hydatid cyst embolism should be recognized as a rare but important differential diagnosis in young patients presenting with stroke. Awareness of this potential etiology is essential for early detection, timely intervention, and prevention of severe neurological complications. Cardiac hydatid cysts are infrequent, representing 0.5%-2% of all hydatid disease cases. The left ventricular wall is the most common location for cardiac disease, while interventricular septum involvement is much rarer. Echocardiography is favorable as a non-invasive diagnostic tool with high sensitivity and low cost. Surgical removal with open heart surgery is the treatment of choice for such cysts. Here, we report a case of a hydatid cyst in a 17-year-old patient in the interventricular septum complicated with cerebral embolization. A 17-year-old male presented with a month-long history of right-sided muscle weakness and slurred speech. Neurological examination revealed weak motor power (3/5) in the right upper and lower extremities with hypertonia, hyperreflexia, Babinski sign, and expressive aphasia. Brain MRI showed multiple lesions, including an irregularly shaped area in the left frontal lobe and two lesions in the left occipital-parietal region. A CT neck of the neck, chest, abdomen, and pelvis (NCAP) showed the presence of a cystic heterogeneous formation located at the level of the cardiac interventricular septum. Our decision was surgical removal of the cyst with open-heart surgery. The cystic germinal layer was completely resected, and the cavity was marsupialized. The case reported here is of particular interest not only because a hydatid cyst is located in the interventricular septum but also because the giant hydatid cyst was detected by neurological symptoms without any previously noted cardiac manifestations. Embolism of hydatid cysts should be considered in the differential diagnosis of stroke in young patients, especially in endemic areas.