Diverse Presentation of Intraventricular Colloid Cysts – A Tale of Eight Cases

Abstract

Introduction: Colloid cysts are one of the benign intracranial tumors most commonly occurring in the rostral part of the third ventricle. These may present with varied spectrum of clinical features that poses challenges in clinical diagnosis. The presentation may range from being asymptomatic to simple headaches, seizures, and even sudden death. Most of the symptoms can be attributed to the development of obstructive hydrocephalus. Chemical or aseptic meningitis is unusual complication posing complicating differential diagnosis. We describe eight such cases with wide variety of symptoms.
Materials and Methods: We present a case series of eight cases of the third ventricle colloid cysts presented at our institute. Age of the patients ranged from 15 to 55 and five of them were females. All the clinical features were recorded from each one of them. Computed tomography and magnetic resonance imaging were used to diagnose the condition. Four of them underwent excision of the cyst in single stage either by open or endoscopic approach. Two patients underwent preliminary ventriculoperitoneal shunt done in the view of poor neurological status and craniotomy and excision was done in later stage. In one patient bedside external ventricular drain was inserted for emergency decompression of ventricles. One patient is under serial radiological follow-up.
Results: Eight cases that we observed had wide variety of symptoms. Six patients had chronic headache with progressive severity, and four of them had nausea with vomiting, three patients had seizures. The cysts in two patients were discovered accidentally, during the evaluation of seizures in one patient and others in evaluation of traumatic head injury. One elderly patient had presented with psychiatric symptoms, drop attacks along with the features of normal pressure hydrocephalus. One teenage patient presented with sudden deterioration and went into cardiac arrest even after emergency decompression of ventricles done. Seven of them underwent surgery and one of them succumbed. The surgery improved health in all other seven patients.
Conclusion: Colloid cysts may present with a wide range and beyond expected neurological manifestations. The severity or rapid clinical deterioration does not exactly correlate with depending on the site, size of the cyst. Leaking cysts with chemical meningitis may further complicate the diagnosis. Hence, early diagnosis and surgery with complete removal of cysts offer better clinical outcomes in those patients.