European Geriatric Medicine 1 (2010) 308–309
EGM clinical case
Colloid cyst of third ventricle T. Fraisse 1,*, S. Sirvain 1 CSGA, centre hospitalier d’Ale`s, 811, avenue du Dr-J.-Goubert, 30100 Ale`s, France
Computed tomography (CT) without contrast product showed a 23 mm hyperdense spheric tumor of the third ventricle (Fig. 1). The cerebral Magnetic Resonance Imaging (MRI) described a ponto cerebellar ischemic stroke and a lesion hanging on the roof of third ventricle and hyperintense on T1 weighted sequence (Fig. 2). A voluminous colloid cyst was diagnosed. The patient progressively recovered of ataxia and dysarthria. An atrial ﬁbrillation was diagnosed on electrocardiogram and treated with warfarin and a beta-blocker. She did not have previous symptoms suggesting colloid cyst as headaches. In agreement with the neurosurgeon, the colloid cyst was not removed and a follow-up by CT scan was proposed. A colloid cyst is a quite unusual benign tumor that occurs within the third ventricle and can obstruct the cerebrospinal ﬂuid ﬂow . The cyst size range from 2–50 mm and contains colloid material including cholesterol fats responsible of the MRI aspects. Associated signs and symptoms cover a wide range of features, from asymptomatic to intermittent headaches or less commonly nausea, gait disturbance or short-term memory loss. Some colloid cysts can lead to acute hydrocephaly and sudden death . On CT the mass is usually hyper or isodense to grey matter while on MR
A R T I C L E I N F O
Article history: Received 20 June 2010 Accepted 26 July 2010 Available online 17 September 2010
Keywords: Colloid cyst Stroke Aged Brain imaging
An 81-year-old woman was admitted for an acute palsy of the left III oculomotor nerve, dysarthria and ataxia. She had essential hypercholesterolemia and diabetes mellitus as comorbidities. [(Fig._1)TD$IG] only took simvastatin. The blood analyses were normal. The She
Fig. 1. * Corresponding author. Tel.: +33466783156; fax: +33466783356. E-mail address: [email protected]
(T. Fraisse). 1 The two authors have equally contributed to this paper.
1878-7649/$ – see front matter ß 2010 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved. doi:10.1016/j.eurger.2010.07.014
T. Fraisse, S. Sirvain / European Geriatric Medicine 1 (2010) 308–309
T1 weighted imaging it is hyperintense. The axial slides on cerebral imaging will show the lesion hanging on the roof of the third ventricle and sagittal or coronal images will analyze its relation with the foramen of Monro. Microsurgery has been the gold standard using either transcortical-transventricullar or transcallosal approach in an attempt to avoid damage to the fornix and resultant memory loss. Recently stereoscopic and endoscopic approach emerged as a safe approach to avoid neurological and neuropsychological sequelae .
Conﬂict of interest statement The authors declare that they do not have conﬂict of interest. References  Pollock BE, Huston 3rd J. Natural history of asymptomatic colloid cysts of the third ventricle. J Neurosurg 1999;91:364–9.  El-Ghandour NM. Endoscopic treatment of third ventricular colloid cysts: a review including ten personal cases. Neurosurg Rev 2009;32:395–402.