Primary Hydatid Cyst Associated with Sciatica

In this article, the authors report the case of an 81-year-old woman who was diagnosed with a primary hydatid cyst on the thigh. This cyst caused radiating pain down through the left sciatic nerve, as well as numbness and weakness in the left foot and leg.

The patient had initially been treated conservatively with no relief. Following assessment with magnetic resonance imaging (MRI), some disc herniation at L4-5 was detected but with no nerve root compression. Six months later, the patient was seen to have a slowly growing mass on the left thigh.

AFter further testing, a cyst was seen and surgery was performed on the patient. The surgeons discovered a lesion tangled in the sciatic nerve, which they were successful in removing. After the surgery, the patient was given antiparasitic medication and a medication to prevent muscle spasms. Within a few days of the surgery, the pain from sciatica was significantly improved.

While hydatid cysts are not unusual, they are rarely found in the soft tissues. In certain areas of the world, human hydatidosis is still a public health issue that can lead to neurological problems. The authors of this article suggest that physicians must be aware of the possibility of such a cyst, which can be accurately diagnosed using ultrasounds, computed tomography scans (CT scans), or MRIs.

If suspected lesions are found through testing, blood work for serology can confirm the cysts' presence.

Before the cyst can be removed, it's essential that the patient be tested for hydatidosis, a tissue infection of the parasite. If there is such an infection, if it is exposed during surgery, the patient is at increased risk of anaphylaxis. This diagnosis, however, isn't easy. Biopsies are not recommended because of the anaphylaxis risk and the risk of contaminating nearby tissues. Acknowledging this difficulty, the authors of this study chose to remove the mass while contained in the muscle tissue, rather than just removing the cyst alone.

There are reports in the literature of physicians who used chemotherapy and percutaneous treatments to shrink the cysts and avoiding the need for surgery. The medication albendazole has been effective.

The authors conclude that physicians should consider the hydatid cyst as a possible diagnosis, particularly if the patient is from an area where the possibility is high.

Aydiner Kalaci, MD, Teoman Toni Seving, MD, and Ahmet Nedim Yanet, MD. Sciatica of nondisc origin: hydatid cyst of the sciatic nerve. In Journal of Neurosurgery: Spine. April 2008. Pp. 394-397.

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