Symptomatic lateral ventricular cystic lesion in a young cat

Abstract

Case summary A 1.5-year-old male neutered Persian cat was referred for acute deterioration of chronic left head tilt and ataxia. A lateral intraventricular cystic lesion, closely associated with the left choroid plexus, was identified on MRI. The intralesional signal intensity and cytological analysis of the fluid revealed a liquid similar to cerebrospinal fluid. After trepanation, an endoscopic-assisted fenestration and aspiration of the cyst were performed to temporally relieve the high intracranial pressure while waiting for surgical cystoperitoneal shunt placement. Three weeks after surgery, clinical relapse and recurrence of the lesion were noted on the pre-cystoperitoneal shunting MRI. During anaesthesia, the cat arrested. Cardiac resuscitation was successfully performed and cystoperitoneal shunting was postponed. Global brain ischaemia was then suspected, based on major forebrain clinical signs and MRI abnormalities. During a 6-month recovery period, a further three fine-needle CT-guided aspirations of the lesion were required, owing to clinical recurrence and increased cyst size. Cystoperitoneal shunting was eventually performed, allowing persistent reduction of the lesion and long-term improvement of the cat’s neurological status. Relevance and novel information This is the first report of a symptomatic lateral intraventricular cystic lesion in a cat. A left lateral intraventricular choroid plexus cyst was suspected based on the MRI features. Our case suggests that endoscopic fenestration and CT-guided aspiration are not adequate treatments for long-term management. Cystoperitoneal shunting may be a safe procedure, allowing significant and stable reduction of the cystic lesion, associated with improvement in the cat’s neurological status by preventing high intracranial pressure.

MRI features of a presumed noncolloidal intraventricular cyst in a young cat

“…Our literature review found only one previously reported case of an intraventricular cyst in the lateral ventricle in a cat by Debreuque et al, 9 who reported a symptomatic presumed choroid plexus cyst in the lateral ventricle. However, histopathological and immunohistochemical examinations were not performed, and it therefore remains uncertain if this lesion truly represented a choroid plexus cyst.…”

“…They have similar intensity to CSF, the cyst wall is visible in T1w MR images but not on CT images, and the cyst wall is easily detected even although the cyst wall is very thin and closely applied to the ventricular lining. 5,6,8 Our literature review found only one previously reported case of an intraventricular cyst in the lateral ventricle in a cat by Debreuque et al, 9 who reported a symptomatic presumed choroid plexus cyst in the lateral ventricle. However, histopathological and immunohistochemical examinations were not performed, and it therefore remains uncertain if this lesion truly represented a choroid plexus cyst.…”

“…Treatment for symptomatic intraventricular cysts includes cystoperitoneal shunt and surgical resection 9 . Treatment was declined by the owner of our patient, although even with treatment, the prognosis remains poor.…”

“…[10][11][12][13][14][15] In cats, intracranial cysts have been rarely reported with only isolated reports of arachnoid diverticula [16][17][18] and the above-mentioned case of a presumed choroid plexus cyst within the left lateral ventricle. 9 Platt and colleagues 10 reported that the vast majority of these cystic lesions were located in an infratentorial location or, in the case of arachnoid diverticula, in the region of the quadrigeminal cistern.…”