• C J Opperman, J M N Enslin, J Nuttall, A J Brink, S P Da Fonseca, and H D Tootla.
• Microbiology Laboratory, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa; Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa; Green Point Tuberculosis Laboratory, National Health Laboratory Service, Cape Town, South Africa. Stefanopperman1@gmail.com.
• S. Afr. Med. J. 2021 Nov 5; 111 (11): 1050-1054.

AbstractA previously healthy 10-year-old girl, living in a sheep-farming community in South Africa with exposure to dogs, presented to her local hospital with generalised tonic-clonic seizures. The initial clinical assessment and laboratory work-up were unremarkable. When she presented with further seizures 6 months later, attempts to arrange neuroimaging and specialist assessment were unsuccessful owing to restrictions on routine healthcare services during the SARS-CoV-2 nationwide lockdown. Subsequently, 11 months after her first presentation, she developed focal neurological signs suggestive of raised intracranial pressure. A brain computed tomography scan revealed a left-sided cerebral cyst and imminent tonsillar herniation. An emergency burr-hole procedure was performed to relieve the raised intracranial pressure, followed by definitive neurosurgical excision of cysts. Hydatid protoscolices and hooklets were seen on microscopy of cyst fluid, and treatment with albendazole and praziquantel was initiated. While her infection was treated successfully, long-term sequelae including permanent blindness and hemiparesis could potentially have been prevented with early neuroimaging and surgical intervention.

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