A 47-year-old man, with a history of primary systemic hypertension and anxiety disorder with agoraphobia, was admitted in our department with acute-onset speech impediment and loss of strength in the right side of his body, accompanied by headache, vomiting, and deterioration of his level of consciousness. A Glasgow Coma Scale (GCS) score of 8 [E2, V2, M4 (E: Eye response, V: Verbal response; M: Motor response)] and a right-sided hemiplegia were noted during his initial assessment in the emergency room. His arterial blood pressure was found to be 210–140 mmHg. Acute obstructive hydrocephalus due to a rounded hyperdense mass within the third ventricle was revealed on the emergency brain computed tomography (CT), in addition to a moderate size acute hematoma in the left basal ganglia [Figure and ]. The immediate placement of an external ventricular drainage in the frontal horn of the right ventricle allowed controlled evacuation of blood-stained CSF and alleviation of intracranial hypertension (initial value of 32 mmHg). After clinically stabilizing the patient, a presumed diagnosis of a colloid cyst within the third ventricle was made by magnetic resonance imaging (MRI) []. The tumoral lesion was completely removed 2 days later through a right far lateral interhemispheric transcallosal approach.[] Pathological analysis of the lesion confirmed the diagnosis of a colloid cyst with vascular congestion and foci of acute bleeding within its wall []. The patient developed postoperative bifrontal pneumocephalus that spontaneously resolved itself over a period of several days. Once the CSF pathways’ permeability was restored, the ventricular drain was removed with favorable evolution. Follow-up MRI study confirmed total resection of the lesion []. Right-sided hemiparesis (3/5) with impaired propioception and a mixed type sensitive and motor disphasia persisted at the latest follow-up assessment 1 year after surgery. Neuropsychological assesment revealed bradipsychia, anosognosia, as well as attention, concentration, and working memory significant deficits.
Interestingly, an 11-year-old girl with a long history of headache was referred to undergoing a brain MRI. The MRI was performed with 1.5 Tesla Siemens machine.\nA well-defined rounded abnormal signal intensity lesion was visualized at the foramen of Monro resulting in moderate acute hydrocephalus. The lesion was isointense to gray matter on T2WI and hyperintense on T1WI and FLAIR images. No drop of the signal was visualized in T2 GRE sequence to suggest intralesional hemorrhage. No diffusion restriction was noted. Subtle enhancement of the lesion was seen on postcontrast images (Figures and ).\nThe first case did not receive any surgical treatment and, after ten months of follow-up, he claimed that the symptoms have diminished. The second case was lost of follow-up.