Background and Aims
A 25-year-old Romanian male presented in shock then developed seizures and a left hemiparesis. Early imaging confirmed cerebral infarcts and further investigations showed an unusual infective aetiology.

Method
Case report

Results
This patient attended the emergency department in shock following a collapse. His ECG showed inferolateral ischaemia and troponin was raised. CT aorta showed normal vasculature and an incidental liver cyst. Initial cerebral imaging was normal but after he developed a left hemiparesis, repeat imaging showed a right fronto-temporal infarct with small contralateral infarcts Echocardiography demonstrated a patent foramen ovale but no evidence of endocarditis. Further imaging characterised the liver cyst as suggestive of hydatid disease and contrast-enhanced MRI brain demonstrated bilateral enhancing lesions consistent with hydatid cysts. Anti-hydatid treatment resulted in regression of these lesions.

Conclusion
This case demonstrates how a ruptured hydatid cyst can cause strokes and subsequent cerebral hydatidosis via a patent foramen ovale without detectable colonisation of the endocardium. Cerebral hydatid disease occurs in just 1-2% of all cystic echinococcoses but resultant strokes have only been recognised previously when cardiac colonisation has occurred. Although rare this cause should be considered in patients from endemic areas as treatment with anti-helminthics and anti-platelets has provided good clinical and radiological outcomes.

AN UNUSUAL INFECTIVE CAUSE FOR STROKES