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.
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.