A 20-year-old male patient presented to our outpatient services with complaints of neck pain for 4 months and intermittent vomiting for 2 months duration. General physical examination was unremarkable. Neurological examination revealed left upper limb weakness (power 4+/5, Medical Research Council grading). Rest of the examination was normal.\nGadolinium-enhanced magnetic resonance imaging (MRI) revealed a well-defined lobulated lesion in the ventral cervicomedullary region from medulla to upper border of C2 vertebra. The lesion was heterogeneous in appearance; the anterior part measured 2.8 × 1.6 cm and was hypointense and hyperintense on T1- and T2-weighted images, respectively; while the 1.7 × 1.1 cm sized posterior part was iso to mildly hyperintense on T1 and heterogeneously hyper intense on T2-weighted sequences [Figure and ]. The anterior part of the lesion was isointense, whereas the posterior part was hyperintense on fluid attenuation and inversion recovery (FLAIR) sequences. There was mild restriction on diffusion-weighted sequences. On post-contrast study, rim enhancement was evident in the posterior part of the lesion []. Preoperative diagnosis was neurenteric cyst. Surgery was performed in prone position. A midline suboccipital craniectomy (with bone removal more on left side), left-sided C1 posterior arch removal, and partial C2 hemilaminectomy were performed. Intraoperatively, there was a well-defined, intradural, extra-medullary encapsulated, relatively avascular, lobulated lesion containing easily suckable, cheesy material located anterior to medulla extending up to C2 vertebral level. Vertebral artery, lower cranial nerves, and posterior inferior cerebellar artery were well visualized and preserved. Tumor decompression was followed by near total excision of the cyst wall in view of adherence of the cyst wall focally to surrounding vital structures. Postoperative course was uneventful and he was discharged on 7th postoperative day and is currently on regular follow-up. At the last follow-up of 3 months, patient was well with no deficits. Postoperative MRI showed a very small residual lesion [].\nHematoxylin and eosin photomicrographs showed epithelial lining thrown into folds along with irregular bundles of collagen. Higher magnification images show a prominent columnar epithelial lining with goblet cells focally thrown into papillary formations (×100), pseudostratification, and absence of cilia (×400). Overall features were consistent with an endodermal (neurenteric) cyst of Hind-gut type [Figure and ].
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.