Large hemorrhagic colloid cyst in a 35-year-old male

Abstract

Colloid cysts are rare benign tumors of the third ventricle with diverse clinical presentation, which vary from incidentally found cysts to acute death. An uncommon hemorrhage in these cysts is a life threatening complication which can cause obstructive hydrocephalus with acute deterioration of the patient and sudden death. We present a case of 35-year-old man with large hemorrhagic colloid cyst of a third ventricle causing acute obstructive hydrocephalus even though magnetic resonance image with low T2 signal of the cyst suggested its clinically stable nature. Only 3 cases of in vivo diagnosed hemorrhagic colloid cysts have been reported in the literature. ÖZKolloid kistler üçüncü ventrikülün nadir benign tümörleri olup tesadüfen bulunan kistlerden akut ölüme kadar çok geniş bir klinik sunum aralığına sahiptir. Bu kistlerde sık görülmeyen bir olay olan kanama obstrüktif hidrosefaliye ve sonuçta hastanın durumunda ani bozulmaya ve ölüme neden olabilen yaşamı tehdit edici bir komplikasyondur. Üçüncü ventrikülde büyük bir hemorajik kolloid kisti olup kistte düşük T2 sinyaliyle manyetik rezonans görüntülemenin klinik olarak stabil bir durum düşündürdüğü akut obstrüktif hidrosefali bulunan 35 yaşında bir erkek sunuyoruz. Literatürde in vivo tanı konmuş sadece 3 hemorajik kolloid kist vakası mevcuttur.anaHtar sÖZcÜkLer: Kolloid kist, Kanama, Üçüncü ventrikül, Hidrosefali

Colloid cysts of the third ventricle exhibit various clinical presentation: a review of three cases

“…An increase in the cyst volume may be possible due to accumulation of its content and as a result of bleeding into the cyst. Both increase the cyst volume, which may result in sudden death [5,8,18]. Headache and worsening of consciousness in the setting of cyst enlargement may arise from blockage of foramina Monroe, ventricles and consequent brain herniation [8].…”

“…Colloid cysts are rare congenital and benign intracranial tumors, representing up to 2% of all intracranial neoplasms [1][2][3]. They usually occur in the anterior and anterosuperior part of the third ventricle [4,5]. The cysts may cause obstruction of the foramen Monroe and as a result of impeded cerebrospinal fluid (CSF) flow; hydrocephalus with lateral ventricle dilatation may form.…”

Hemorrhagic colloid cyst

“…All cases demonstrated the typical imaging features associated with a hemorrhagic colloid cyst, including hypointense areas along the wall of the cyst on T2-weighted images and susceptibility artifacts, which are suggestive of a bleed; these were histopathologically confirmed. 2,3,[9][10][11][12][13][14][15][16][17][18][19] The first clinically diagnosed case of a hemorrhagic colloid cyst, reported by Beems et al, 2 was initially treated by an emergency ventriculotomy followed by elective endoscopic cyst removal. Additionally, Carrasco et al, 11 reported a case of a hemorrhagic colloid cyst where a safe surgical strategy was employed, consisting of elective microsurgical removal following EVD.…”

“…In fact, most of the reported cases were also treated with a similar approach (Table 1). 10,[13][14][15][16][17][18][19] Only one case presented with abrupt anterograde amnesia, which was treated by direct emergency neuro-endoscopic excision of the cyst; this patient demonstrated complete resolution of the anterograde amnesia following surgical removal of the cyst. This case emphasized the importance of timely surgical excision on rapid improvements in memory disturbances.…”

“…The outcomes were poor in 4 cases, 2,10,11,19 satisfactory in 3, 9,14,15 and good with complete resolution in 5. 3,13,[16][17][18] All 4 cases that experienced poor outcomes tended to undergo rapid clinical deterioration following their initial presentation.…”