A 41-year-old gentleman presented to the eye clinic complaining of seeing floaters before both eyes since 2 weeks. On questioning, he admitted getting intermittent dull headache of mild to moderate intensity and dizziness on and off while walking since 2 months. There was no associated nausea or vomiting or other neurological symptoms. He was detected to be a hypertensive few months ago and was on treatment with lisinopril 5-mg daily.\nOcular examination revealed a best-corrected Snellen's visual acuity of 6/6 p in both eyes. Anterior segment examination showed exotropia of about 45° in left eye that was alternating. Rest of anterior segment examination including intraocular pressure was normal. Fundoscopy of the right eye revealed early vitreous hemorrhage. The disc showed slight blurring of margins associated with peripapillary retinal hemorrhages []. Fundus examination of the left eye showed early vitreous hemorrhage and blurring of disc margin. There was a small area of preretinal hemorrhage inferior to the disc []. B scan ultrasound also confirmed early vitreous hemorrhage.\nA diagnosis of bilateral early disc edema with mild vitreous hemorrhage was made, and he was investigated. Contrast-enhanced CT scan of brain showed a well-defined oval nonenhancing hyperdense lesion measuring 2 × 1.9 × 2.3 cm at the anterosuperior aspect of third ventricle bulging through the right foramen of Monro and compressing the left foramen of Monro causing dilatation of both lateral ventricles with cerebrospinal fluid (CSF) seepage []. Fourth ventricle appeared normal. Moderate 0.8-cm midline shift was also seen to the left side.\nA presumptive diagnosis of colloid cyst causing moderate obstructive hydrocephalus was made, and he was referred urgently to the department of neurosurgery. He underwent emergency craniotomy and cyst excision. Histopathological examination of the excised tissue showed cyst contents lined by cyst wall lined by ciliated cuboidal epithelium resting on fibrocollagenous tissue consistent with colloid cyst. Postoperative CT scan showed pneumocephalus and subdural collection in the right frontotemporal region that resolved spontaneously after few days.\nThe patient improved symptomatically following surgery. On follow-up after 1 month, he reported complete resolution of floaters and headache.\nFundus evaluation showed resolving vitreous hemorrhage and disc edema. Follow-up after 3 months showed complete resolution of disc edema and vitreous hemorrhage [Figure and ]. He is being followed up closely for recurrence of symptoms. He has remained asymptomatic for the last 18 months after the intervention.
The patient was a 47-year-old female who presented to the emergency department with acute headache and nausea/vomiting. She did not mention any previous history of severe headache or vomiting. On the neurologic examination papilledema was noted. There were no focal neurological deficits. She was dizzy but conscious and her Glasgow coma scale (GCS) score was 13. Computed tomography (CT) scan of the brain revealed enlargement of lateral ventricles and a well-circumscribed hyperdense mass on the roof of the third ventricle at the location of foramen of Monro (). On MRI examination, a hyperintense rim was seen around lateral ventricle on FLAIR sequence that was compatible with interstitial edema and acute nature of hydrocephaly (). A T2-hypointese (), T1-isointense mass was seen on the roof of the third ventricle (). The characteristic location and MRI signal intensity were consistent with colloid cyst. Blooming artifact was visible on susceptibility weighted sequence () and suggested the hemorrhagic nature of the lesion and explained the occurrence of acute hydrocephaly.\nThe patient underwent ventriculostomy followed by craniotomy and tumor resection and experienced an uneventful recovery. Histological examination confirmed the diagnosis of hemorrhagic colloid cyst.