MedPix® Patient Chart - Case No: 13124 :: - Review Images

53 year old man was in an MVA (struck by another car) 1 month ago. At that time, an outside CT scan done in the ER revealed a "mass in the center of the brain."

No focal neurologic signs or symptoms

- Review Images for PT: 13124

• Cystic mass in the roof of the Third Ventricle
• Mild dilatation left lateral ventricle
• No enhancement of mass

- Review Images for PT: 13124

• Cysticercosis
• Endodermal cyst
• Colloid cyst
• Ependymoma
• Central Neurocytoma
• Meningioma

- Review Images for PT: 13124

Dx: Colloid Cyst

Dx Confirmed by: Imaging and Surgery

- Read

Surgery via a transcollosal approach

Video - - LINK -

Zamponi N, Rychlicki F, Trignani R, Polonara G, Ruggiero M, Cesaroni E: Bobble head doll syndrome in a child with a third ventricular cyst and hydrocephalus.
Childs Nerv Syst. 2005 May;21(5):350-4. Epub 2004 Sep 21.

INTRODUCTION: The bobble head doll syndrome, mainly affecting children under 10 years of age, is a rare and surgically treatable movement disorder characterized by head bobbing occurring at a rate of 2-3 times/s. Its pathophysiological mechanism is not well known but two main factors are commonly associated with the condition: a dilatation of the third ventricle and, more frequently, a cystic lesion rather than a solid mass in the region of the third ventricle. ILLUSTRATIVE CASE: The illustrative case concerns a child with a third ventricular cystic lesion and hydrocephalus who had experienced abnormal head movements since the age of 1 year as well as ataxia and tremor of the arms. Contrast cranial MRI, at the age of 3, demonstrated enlargement of the third and lateral ventricles, a ballooned cyst inside the third ventricle with compression of all the diencephalic structures, a funnel dilation of the cranial part of the aqueduct, and a cyst in the septum pellucidum. A ventriculoperitoneal shunt (Hakim-Cordis) was placed and the head bobbing, tremor of the arms, and ataxia disappeared immediately. CONCLUSION: The good and immediate clinical result in our case emphasizes the opinion that the reduction of CSF pressure is the best therapeutical option in the bobble head doll syndrome.

[PubMed]
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Armao D, Castillo M, Chen H, Kwock L: Colloid cyst of the third ventricle: imaging-pathologic correlation.
AJNR Am J Neuroradiol. 2000 Sep;21(8):1470-7.

Colloid cysts are relatively rare intracranial lesions located in the rostral aspect of the third ventricle. They may produce acute hydrocephalus, brain herniation, and lead to death. Although the clinical and imaging features of colloid cysts are well known, their etiology and the factors responsible for their imaging features continue to be a subject of debate. We present the imaging-pathologic correlation of a patient with a colloid cyst as well as data supporting the fact that the presence of cholesterol is probably responsible for the MR imaging features exhibited by some colloid cysts.

[PubMed]
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Urso JA, Ross GJ, Parker RK, Patrizi JD, Stewart B:Colloid cyst of the third ventricle: radiologic-pathologic correlation.
J Comput Assist Tomogr. 1998 Jul-Aug;22(4):524-7.

We describe a patient with a large colloid cyst of the third ventricle and resultant hydrocephalus. An unenhanced brain CT demonstrated the central portion of the mass to be of increased density relative to the peripheral portion. On T1-weighted images, the central portion of the mass was of increased signal intensity relative to brain, whereas the periphery was isointense. On T2-weighted images, the central portion was markedly hypointense to brain, while the peripheral portion was isointense. These imaging findings corresponded to an actual pathological difference between the central and peripheral portions of the mass. The central portion was solid, whereas the periphery was liquid. Since no histological difference was identified between the central and peripheral portions of the mass, we hypothesize that the differences in densities on CT and signal characteristics on MR were related to the state of hydration in the mass where the central portion possibly had a higher protein concentration than the periphery.

[PubMed]