Symptomatical colloid cyst_Torfs
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Transcript of Symptomatical colloid cyst_Torfs
A 45-year old patient with headache
DEPARTMENT OF RADIOLOGY, 28-05-2013
M. Torfs, AZ Middelheim
Patient presentation [1]
45-year old Caucasian male
Past medical history:- glaucoma
Patient presentation [2]
History of present condition:- fall on his forehead 12 days before admission, while doing push-ups- headache since a few days after the fall- since three days aggravation of the pain, especially when bending forward- temporary loss of sight (10 minutes)
Clinical examination:- normal orientation, normal consciousness- symmetric reflexes
NECT (15/03/2013)
NECT (15/03/2013)
NECT (15/03/2013)
NECT (15/03/2013)
NECT (15/03/2013)
NECT (15/03/2013)
NECT (15/03/2013)
NECT (15/03/2013)
NECT (15/03/2013)
NECT (15/03/2013)
NECT (15/03/2013)
Diagnosis?
NECT CECT Supratentorial obstructive hydrocephalus (with periventricular edema)
Isodense/slightly hyperdense mass 3th ventricle, no enhancement
Diagnosis
Supratentorial hydrocephalus, caused by a colloid cyst
MRI (18/03/2013)
FLAIR, AX T2-WI, AXT2-WI, COR
Colloid cyst: epidemiology
Incidence: 1/1.000.000 (person-years)- account for 0.5%-1.0% of all intracranial tumors- represent 15%-20% of intraventricular masses
Most become symptomatic between the 3rd and 5th decades of life
M/F 1:1
Rare in children (only 1%-2% occur under 10y)
Colloid cyst: etiology and APD Etiology not well understood
Leading theory: ectopic endodermal elements migrate into the velum interpositum during CNS embryonic development
Cyst wall is lined with a mixed array of epithelial and goblet cells secreting proteinaceous mucinous fluid (may be responsible for the increase of size)
Cyst cavities may be filled with blood degradation products such as cholesterol crystals
http://www.pathology.vcu.edu/WirSelfInst/neuro_medStudents/tumor-2.html
Colloid cyst: clinical features
Symptoms of intermittent or prolonged increased intracranial pressure
Most common symptoms:- headache- vertigo- memory deficits- behavioral disturbances- diplopia
Sudden interruption of CSF circulation with coma and death have been reported
Malignant degeneration does not occur
Colloid cyst: imaging features [CT] 2/3 of colloid cysts are homogeneously
hyperdense, 1/3 are isodense (to brain) well-delineated, round or ovoid, noncalcified located anterior in the 3rd ventricle (wedged
in foramen of Monro) enhancement: usually absent, sometimes thin
rim of enhancement
Colloid cyst: imaging features [MRI] Wide variation of signal characterisation
Most common: hyperintense on T1-WI, hypointense on T2-WI
Rim enhancement in some cases
! CSF flow artefacts can mimic colloid cysts ! (clue = location)
Colloid cyst: imaging features [MRI]
Patient 1
Patient 2
Colloid cyst: differential diagnosis
Normally pathognomonic
CSF flow artefacts!! (MR pseudocyst) Intraventricular meningioma Neurocysticus cyst Subependymoma Choroid plexus papilloma
Colloid cyst: treatment
Surgery:- transcortical approach- interhemisperic transcallosal approach- endoscopic approach
Colloid cyst: complication
Quick progressive supratentorial hydrocephalus with transtentorial herniation
Colloid cyst: take home messages
Adults 20-40 years
Variation in density (CT) and signal features (MRI), located anterior in the 3rd ventricle (wedged in foramen of Monro)
Associated with sudden death
References
Osborn A, Diagnostic Neuroradiology
Emedicine
Radiopaedia.org
de Witt Hamer PC, Verstegen MJ, De Haan RJ, Vandertop WP, Thomeer RT, Mooij JJ, van Furth WR. High risk of acute deterioration in patients harboring symptomatic colloid cysts of the third ventricle. J Neurosurg. 2002 Jun;96(6):1041-5