Familial Colloid Cyst of the Third Ventricle in Monozygotic Twins

Abstract

J Neurol Stroke 2017, 6(6): 00219 mm versus 8 mm), 3) ventricular dilation (83% versus 31%),and 4) increased signal on T2-weighted magnetic resonance images (44% versus 8%) [1]. More than half of cases were discovered incidentally. In five patients with incidental cysts (8.8%) an enlargement of the cyst was documented and a surgical procedure was done. Nearly half of symptomatic patients present hydrocephalus, more than 10% present an acute symptom, and 1% of patients decease due to obstructive hydrocephalus and herniation [1].Some familial cases were previously reported, including monozygotic and dizygotic twins. Most of the familial colloid cysts were treated operatively, although few cases were treated conservatively, with regular radiological follow up [7][8][9]. To our knowledge, only 4 pairs of twins with colloid cyst have been previously reported in the literature, three of which are monozygotic and the other one is dizygotic [10][11][12][13].In this report, we present the fourth monozygotic twins with this potentially life-threatening pathology. The two brothers were operated four years apart after presenting with different clinical scenarios. Clinical Presentation Brother AThe 31-years-old (Figure 1) patient was admitted to a hospital in another country in 2012 following a generalized tonic-clonic seizure. After first stabilization the patient was neurologically intact without any signs and symptoms of increased intracranial pressure. A prophylactic antiepileptic therapy with levitracetam was initiated. An MRI was done and showed an isointense in T1 and T2WI and a hyperintense mass in the fluid attenuated inversion recovery sequence suggesting the diagnosis of a colloidal cyst of the third ventricle causing the pathognomonic obstructive hydrocephalus involving only the lateral ventricles (Figures 2-5).