Presentation
Severe headache.
Patient Data
Large cystic lesion occpying and expanding the 3rd ventricle and obstructing the foramina of Monro with the shunt tube seen to decompress the ventricles. The cyst contains fluid that is higher than CSF on signal in T1, lower than CSF signal on T2 and hyperintense signal on FLAIR. Another component is seen invaginating into the frontal horn of right lateral ventricle is seen with low signal on FLAIR. Minimal enhancement of cyst wall with no nodules or septations.
Diagnosis: Colloid cyst (pathology proved)
Removal of the cyst was done through a transcallosal approach. Post operatively an acute infarction of the genus of right internal capsule had developed as evident on DWI and ADC. Also there is edema and swelling of the corpus callosum with mild restricted diffusion. Some of the cyst contents are seen at the occipital horn of both lateral ventricles forming CSF/fluid level. The small component within the frontal horn of right lateral ventricle is still seen unaffected.
Case Discussion
Colloid cyst is benign lesion arises from the roof of 3rd ventricle and may obstruct the foramen of Monro causing obstructive hydrocephalus. The cyst contents and hence it signal intensity varies.
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