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.
We present a case of a 36-year-old male who was admitted to the hospital due to a 1-month history of daily headaches within the occipital region. The headaches were reported to be worse at night and occasionally accompanied by nausea and dizziness. Neurological examinations revealed a right-sided exaggerated tendon reflex compared to the contralateral side. The patient was diagnosed with a positive pyramidal syndrome, Hoffmann’s reflex, and Babinski’s and Rossolimo’s sign on the right side. A CT scan revealed a 20 × 15 × 23 mm isodense focal lesion in the posterior fossa at the level of the foramen magnum []. The lesion extended to the level of the dens of axis while compressing the spinal cord posteriorly. Proton density [], T1 [ and ], and T2 [ and ] weighted MRI scans revealed a 22 × 11 × 33 mm well-defined cystic mass with two heterogeneous compartments within the foramen magnum at the level of C1-2. The medulla and spinal cord were shown to be displaced and compressed along with remodeling of the vertebral arteries with the right artery mainly affected. The superior half of the lesion was hyperintense on T2WI [] and moderately hypointense on T1WI MRI []. The inferior half of the lesion was hypointense on T2WI and hyperintense on T1WI MRI. No enhancement was shown after contrast administration. After careful consideration, the far lateral approach was chosen, and the patient underwent preparation for the procedure. A J-shaped skin incision followed by a suboccipital craniotomy, C1 laminectomy, and a C2 hemilaminectomy was performed. The dura was opened, exposing the extramedullary cyst. Complete resection (CR) was achieved and a cranioplasty with a typical closure concluded the operation. A histological examination revealed the cyst to be most consistent with a type B NC. The postoperative course was uneventful, and the patient was discharged on the 7th day without any neurological deficits. In a later follow-up, a CT scan revealed no sign of cyst recurrence.