Hydatid disease is an endemic zoonotic disease in many areas of the world. Liver, followed by lung, is the most commonly affected organ and involvement of other organs is rare. When brain is involved, lesions are typically supratentorial, and infratentorial localisation is even rarer. We present a 45-year-old woman with hydatid disease located in premedullary location compressing the brain stem, an exceedingly rare location for cerebral echinococcosis. Relevant literature regarding typical properties of cerebral disease was reviewed. 1. Introduction Hydatid disease is endemic in many areas, especially in the Middle East, Turkey, South America, South Europe, New Zealand, and Australia [1–3]. The patients are usually asymptomatic or their symptoms are nonspecific since growth of the cysts is generally slow and therefore clinical manifestations tend to be nonspecific complaints due to compression of involved organs [2, 4]. The diagnosis depends on clinical suspicion, typically based on a history of living in, or having travelled to, an endemic area and contact with cattle or dogs and is confirmed with serologic tests and imaging [3]. The most common locations for hydatid cysts are the liver, followed by the lung [1, 2]. However, many parts of the body can be affected, including bones, pericardium, orbits, and brain [1, 5]. Cerebral localization is extremely rare, being seen in 2-3% of systemic disease and forming 2% of all intracranial space occupying lesions [2, 3, 5]. This rarity, coupled with nonspecific symptoms, necessitates a high degree of clinical suspicion and thus presents a diagnostic difficulty. We present a case of infratentorial cerebral hydatid disease with an exceedingly rare location, followed by a review of the literature regarding typical characteristics and imaging findings of cerebral echinococcosis. 2. Case A 45-year-old woman applied to a different center with complaints of nausea, vomiting, and headache that has been going on for three months. Following tests and examination, she was referred to our center with the initial diagnosis of a mass. Her physical examination revealed monoparesis in the left lower extremity and hypoesthesia on the left but was otherwise normal. Magnetic resonance imaging (MRI) in our center revealed an extra-axially located cystic lesion with a thin wall in the premedullary location compressing brain stem. The patient was operated and the lesion was revealed to be hydatid cyst (Figure 1). Figure 1: (a) T1W sagittal, (b) FLAIR transverse, and (c) postcontrast T1W transverse images. An unhanced cystic mass is
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