Differential Diagnosis
- Single most likely diagnosis
- Echinococcosis of the brain: The patient has a history of a parasitic liver disease, which suggests a possible diagnosis of echinococcosis (hydatid disease). The presence of cystic formations in the cerebral hemispheres on CT scans, along with symptoms such as headaches, dizziness, numbness, and eventually hemiparesis and altered mental status, supports this diagnosis. Echinococcosis can spread to the brain from a primary site, such as the liver, and cause cerebral hydatid cysts.
- Other Likely diagnoses
- Amoebic encephalitis: Although less likely than echinococcosis given the specific imaging findings, amoebic encephalitis could present with similar neurological symptoms. However, it typically does not cause well-defined cystic formations as seen in this patient.
- Toxoplasmosis meningoencephalitis: This condition can cause cerebral lesions and is a consideration in immunocompromised patients. However, the patient's history and the specific characteristics of the lesions make it less likely than echinococcosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Listeriosis meningitis: Although less common and not directly suggested by the parasitic liver disease history, listeriosis can cause severe neurological symptoms, including meningitis, and is critical to diagnose due to its high mortality rate if untreated.
- Meningococcal meningoencephalitis: This is an acute, potentially life-threatening condition that requires immediate diagnosis and treatment. While the chronic nature of the patient's symptoms and the presence of cystic brain lesions make it less likely, it's a condition that cannot be missed due to its rapid progression and high mortality.
- Rare diagnoses
- Other rare parasitic infections: There are numerous other parasitic infections that could potentially cause neurological symptoms and cystic lesions in the brain, such as cysticercosis or paragonimiasis. However, these would be less likely given the patient's presentation and the more common diagnosis of echinococcosis in the context of a parasitic liver disease.