A 49-year-old woman presented with a new-onset generalized seizure following a brief aura of perioral tingling. Initial head CT demonstrated a right parietal CSF-density cystic lesion without hemorrhage. MRI revealed a 5.5 cm multiloculated non-enhancing intra-axial cyst in the right parietal lobe, initially interpreted as a neuroglial or arachnoid cyst. Eosinophilia doubled from 7.2 to 14. The patient’s remote history of exposure to cattle and dogs in Cambodia prompted evaluation for parasitic infection. 

Echinococcus ELISA was positive, although Western blot confirmation was unavailable nationally. Unruptured hydatid cysts can appear non-enhancing, CSF-isointense, and without surrounding edema. Ophthalmologic examination revealed a left homonymous hemianopia. Systemic imaging identified a solitary 8 mm pulmonary nodule without hepatic lesions. Given exposure history, serology, and imaging features, an inactive cerebral hydatid cyst was deemed likely. Although surgical excision and histopathological confirmation is the gold standard for diagnosis, surgery was deferred due to rupture risk. The patient was managed conservatively with levetiracetam and remained seizure-free on follow-up