32-year-old lady presented with complaints of oligomenorrhoea since 9 years; tremor of both hands since 9 months; intermittent right frontal headache, drop attacks, urinary incontinence, somnolence and irrelevant laughing since 6 months. On examination, there was bilateral secondary optic atrophy. No other cranial nerve involvement. Power was grade 3/5 in both upper limbs and grade 4+/5 in both lower limbs. Deep tendon reflexes were brisk. Bilateral cerebellar signs were present.\nMRI [] showed a suprasellar lesion elevating the floor of the fourth ventricle and extending into the interpeduncular fossa posteriorly. It appeared iso- to mildly hyperintense on T1 weighted images and hyperintense on T2 weighted images. There was facilitated diffusion in the lesion with high ADC values. There was no blooming on gradient echo images. There was no obvious enhancement on administration of contrast. On MR spectroscopy, there was a prominent peak at 2.02 ppm corresponding to NAA like compound. The third and lateral ventricles were dilated with periventricular hyperintensities suggestive of transependymal seepage of CSF.\nThe patient underwent right frontotemporal craniotomy, single peice orbitozygomatic osteotomy and subtotal excision of the lesion. Histopathology showed ciliated columnar, pseudostratified columnar, stratified squamous, mucosal glands, clusters of Rosenthal fibres suggestive of neuroepithelial cyst. Based on the immunohistochemical properties, a final diagnosis of neuroenteric cyst was made.
A 17-year-old female patient presented with occasional headache since two years increased since the last three months. On examination, bilateral papilledema was present. No other focal neurological deficits were present.\nMRI [] showed a well-defined CSF-intensity cystic lesion in the region of the fourth ventricle with obstructive hydrocephalus. There were no enhancing solid components. The lesion showed facilitated diffusion. The patient underwent midline suboccipital craniotomy and deroofing of the cyst. Histopathology showed cuboidal or columnar epithelium (pseudostratified at some foci). Based on the immunohistochemical properties, a final diagnosis of neuroenteric cyst was made. Patient did well in the post-operative period with reduction of the hydrocephalus.