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Ependymal cyst, case 2

CLINICAL HISTORY:
This 30-year old female patient has known mental retardation. The family mentions she suffers several episodes of "drop-attacks", but no epileptic, nor cardiac cause was identified. Now she complains of increasing headache and nausea.

NEUROLOGICAL EXAMINATION reveals horizontal nystagmus at left lateral gaze with diplopia. Furthermore a bilateral VIth nerve palsy is noted which had been present for many years.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2200/80/1) SPIN-ECHO SEQUENCE (IMAGE 1): Within the lateral ventricle, an ovoid hyperintense cystic mass is seen, with obliteration of the major part of both lateral ventricles.

b) CORONAL (IMAGES 2 AND 3) AND SAGITTAL (IMAGE 4) T1-WEIGHTED (550/14/1) SPIN-ECHO SEQUENCE: The cyst appears to be located in the left lateral ventricle, with displacement of the septum pellucidum to the right. Flattening of the corpus callosum and depression of the third ventricle are appreciated.

c) CORONAL (IMAGE 5) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCE: No enhancement is noted.

RADIOLOGICAL DIAGNOSIS: Intraventricular cyst, based on the thin wall, the intraventricular location and the CSF content.

SURGICAL FINDINGS: At surgery, the cyst was located within the left lateral ventricle and contained clear, yellowish fluid. The corpus callosum could be seen through the roof of the cyst. The medial cyst wall was tightly adherent to the septum pellucidum. Treatment consisted of resection of the major part of the cyst wall and fenestration of the septum pellucidum.

Video 1
Sequence 1: The cyst is visualized as a bluish mass in the lateral ventricle.
Sequence 2: The cyst wall is incised to obtain marsupialization.

PATHOLOGICAL EXAMINATION (IMAGE 6) shows ependymal cyst.

Search also:
Neuroglial (neuro-epithelial) cysts

 

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Fig. 1

Ependymal cyst, case 2, Fig. 1
Ependymal cyst, case 2, Fig. 2
Ependymal cyst, case 2, Fig. 3
Ependymal cyst, case 2, Fig. 4
Ependymal cyst, case 2, Fig. 5