L’incidence de la localisation intracrânienne de l’hydatidose est relativement rare, 1 à 2 % des cas d’hydatidose. Nous rapportons dans cette observation le cas de deux patients hospitalisés dans notre formation pour des troubles psychiatriques isolés et dont la tomodensitométrie cérébrale a révélé la présence de tumeurs kystiques. Le premier cas est un patient âgé de 29 ans, sans antécédents pathologiques particuliers, hospitalisé pour trouble du comportement, agressivité familiale, délire de persécution et d’ensorcellement et des hallucinations auditives. La TDM faite en urgence devant l’apparition des céphalées et de la confusion a révélé une énorme image kystique au niveau du foramen ovale comprimant le mésencéphale, faisant évoquer le diagnostic de kyste hydatique, qui a été évacué par ponction en neurochirurgie. L’évolution immédiate était favorable. Le second cas est un sujet âgé de 53 ans, admis au service pour agitation psychomotrice, agressivité familiale, propos incohérents, délire de persécution, d’ensorcellement et de préjudice et très discrète hémiparésie gauche. Le scanner cérébral fait en urgence a montré des lésions cérébrales liquidiennes multiples compatibles avec des kystes hydatiques. Le bilan d’extension a révélé une localisation hydatique péricardique, intra-auriculaire gauche et pulmonaire droite.

The hydatidosis is an endemic illness in regions of the Middle Orient, Mediterranean, south of America, north Africa and the Australia. The preferential localization of cyst hydatic is the liver (48 %), the lung (36 %) and in 6 % of cases it localizes in unaccustomed place as the brain. Intracerebral localization is relatively rare, its impact is 1 to 5 % of all cases of hydatidose. This localization is the child’s appendage with a masculine predominance. The cyst hydatic intracranien is often lone, of localization usually supratentorielle, sometimes infratentorielle <sup>[4

Cliquez ici pour aller à la section Références et

Cliquez ici pour aller à la section Références]</sup>. Symptoms are especially the diffuse headache associated to various neurological signs in relation with sits of the tumor <sup>[4HAMDI A, AYACHI R, GARGOURI R et al. Le kyste hydatique du cerveau : à propos d’une série de quatorze cas. Ann Chir 1990 ; 44 (3) : 25-230.

Cliquez ici pour aller à la section Références]</sup>. The psychiatrics symptoms depends on its localization, sides, intracranial hypertension, and the previous personality. In 15 to 20 % of cases these tumors can appear in the beginning of their evolution by the isolated psychiatric symptoms <sup>[3CAMUS V, SCHMITT L. Manifestations psychiatriques des tumeurs cérébrales : approche clinique et thérapeutique. Encycl Med Chir (Elsevier, Paris), Psychiatrie, 37-545-A-16, Neurologie, 17-064-U-12, 2000, 3 p.

Cliquez ici pour aller à la section Références]</sup>. We report the case of two patients that have been hospitalized first in the Academic Psychiatric Unit of Marrakech for isolates psychiatric disorders and whose scanning revealed the presence of cerebral hydatic cyst and that required a surgical intervention in neurosurgery. Case 1 –Patient 29 years old, bachelor, without instruction, leaving in country outside, fermar, in permanent contact with dogs. No particular medical history. The patient has been brought by his family to the psychiatric emergencies after behavior disorders. The beginning of his symptomatology was one year ago by behavior disorders : instability, violence, isolation, and a corporo-sartorial carelessness. His symptomatology worsened and the patient became very aggressive. In psychiatric unit, he was disregarded, sad, anguished, indifferent to his state, very dissonant, completely detached, depersonalized. He brought back some visual and auditory hallucinations with attitude of monitoring. He was raving with delirium of persecution, of ideas of reference and delirium of bewithment. He was unconscious of his disorders. The patient has first been put under classical neuroleptic 9 mg/day of Haloperidol and 200 mg/day of chlorpromazine. The diagnosis of schizophrenia has been kept according to criterias of DSM IV. The PANSS (Positive and Negative Syndrome Scale) was to 137 (score on a positive scale was to 34, score on a negative scale was to 35 and the general psychopathologie scale was to 58). One week after his hospitalization, he develloped headache with a subconfusion, a cerebral scanning has been made in emergency and showed a voluminous cyst in oval foramen compressing the mesencephalon strongly. The cyst was well limited, hypodense, not taking the contrast, and without intracerebral oedema, the diagnosis of cerebral hydatic cyst has been made. The complementary exploration didn’t show any other localizations, and biologic exam results didn’t show any particular anomalies. The patient has been operated in neurosurgery. The immediate evolution was favorable with disappearance of confusion and absence of complications. The patient was lost of view. Six months after, the patient has been readmitted to the psychiatric emergency. He dropped his neuroleptic treatment. He was aggressive, raving, hallucinated and depersonalized. The global score to the PANSS was 63. He has been put back under neuroleptics. Three weeks after improvement and passage of the PANSS to 30, the patient went out. We couldn’t have a cerebral scanner of control because the patient doesn’t had medical assurance and no money for cerebral scanner. Case 2 – Patient aged of 53 years, father of four children, without instruction, original and resident to Marrakech, confectioner as profession. He is in contact with dogs since 12 years. He has been brought to the psychiatric emergencies by his family after an agitation. The history of his illness seemed to go back at eight months ago, by the

progressive apparition of an instability, sleep desorders, hostility, associated with an emotional lability. To the interview he was agitated and had a delirium of persecution. He was convinced that his wife and his children plotted against him. His had sad mood. He was anguished and had auditory and visual hallucinations. The patient was not confused but it had a hypoproxie, an fixing amnesia, a desorders of judgment and a light left hemiparesia. Cerebral scanner revealed three cerebral cyst. The first measuring 42 × 40 mm, sitting at the level parietal right, to the contact of the occipital horn, dragging his/her/its amputation and an effect of mass on ventricle homolateral, the median line and ventricle controlateral. The two other, at the level of the center semi oval, behind the first, measuring 23 mm and 15 mm on the big axis. The patient has been addressed in neurosurgery. He had a completeray exploration to search other localizations. The thoracic x-ray showed 2 pulmunory cyts. The abdominal scan and imagery by magnetic resonance showed liver cyst, peri-heart cyst and mediastinal cyst. The patient has been operat for these three cysts with good recuperation on the psychiatric and neurological symptoms. He has been addressed in heart surgery for the heart localization. The hydatidose is an endemic illness in Morocco and constitute a public health problem. The cerebral localization is rare and appear by signs of cerebral hypertension and signs of focusing. The psychiatric demonstrations are rare but preserve a major interest, by the therapeutic measure specificity that they impose. Of course, the surgical ablation of the tumor can be sufficient to attenuate the psychiatric symptoms but the recourse to a specific treatment can prove to be necessary to act on the precise targets. We are conscious of the methodological difficulties that present these 2 cases but there are unfortunately due to the financial difficulties of our patients.