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.
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.