CASE 771 Published on 06.03.2001

Teaching Case

Section

Neuroradiology

Case Type

Clinical Cases

Authors

B. Lubicz, D. Balériaux

Patient

24 years, male

Categories

No Area of Interest ; Imaging Technique MR, MR, MR ;

No Procedure ; No Special Focus ;

Show more Show less

View full case Show related cases Notify admin

Clinical History

Acute, severe intracranial hypertension in a young adult.

Differential Diagnosis List

Colloid cyst of the third ventricle

Imaging Findings

This patient complained of chronic headaches since almost five years. On the day of admission, he presented with signs of acute intracranial hypertension: severe headache, nausea and vomiting. Neurological examination was normal. An emergency MRI was performed. Sagittal T1WI, axial T1 and T2WI were obtained as well as postgadolinium axial, sagittal and coronal T1WI.

Discussion

Colloid cysts represent 0.5-1% of primary brain tumors. Typical clinical history is made of episodes of brief headaches. Other symptoms include progressive dementia, drop attacks, acute hydrocephalus that may lead to sudden death. Most colloid cysts are rounded-mass, arising in the anterior 3rd ventricle. On CT, they appear slightly hyperdense but occasionely hypo- or isodense. On MRI, about 50% are hyperintense on T1WI and the rest are iso- or hypointense. On T2WI, they appear hypointense. After IV contrast injection, a thin rim enhancement may be seen and represents the cyst capsule. These lesions are treated by stereotactic surgery. After complete resection, cyst recurrence does not occur, but hydrocephalus may persist in up to 30% of cases.

References

[1] Armao D, Castillo M, Chen H, Kwock L.
Colloid cyst of the third ventricle: imaging-pathologic correlation.
Am J Neuroradiol. 2000 Sep;21(8):1470-7. (PMID: 11003281)

[2] Scotti G, Scialfa G, Colombo N, Landoni L.
MR in the diagnosis of colloid cysts of the third ventricle.
Am J Neuroradiol. 1987;(8):370-2. (PMID: 3105293)

[3] Maeder PP, Holtas SL, Basibuyuk LN, Salford LG, Tapper UAS, Brun A.
Colloid cysts of the third ventricle : correlation of MR and CT findings with histology and chemical analysis.
Am J Neuroradiol. 1990;(11):575-581. (PMID: 2112324)

[4] Mamourian AC, Cromwell LD, Harbaugh RE.
Colloid cyst of the third ventricle: sometimes more conspicuous on CT than MR.
Am J Neuroradiol. 1998;(19):875-8. (PMID: 9613503)

Case information