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Ependymal intraventricular cyst

CLINICAL HISTORY:
This 64-year old psychiatric patient manifested an increase in paranoia over the past three months. Recently the patient also notes problems with speech and visual field disturbances.

NEUROLOGICAL EXAMINATION reveals disturbances of memory and understanding. There is a receptive aphasia and a right homonymous hemianopia.

CONTRAST-ENHANCED CT (IMAGE 1) shows a huge cyst within the atrium of the left lateral ventricle.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 2): A very large cystic mass is confirmed within the left lateral ventricle. The content of the cyst is hyperintense, similar to cerebrospinal fluid.

b) CORONAL T1-WEIGHTED (650/20/1) SPIN-ECHO SEQUENCE (IMAGES 3 - 4 - 5): The cyst is clearly located within the left lateral ventricle and reaches up to the tentorium.

c) CORONAL (IMAGES 6 - 7 - 8) AND SAGITTAL (IMAGE 9) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: No contrast enhancement is seen from within the lesion.

RADIOLOGICAL DIAGNOSIS is intraventricular cyst, based on the location in the trigone of the lateral ventricle, the thin wall and the CSF content.

SURGICAL FINDINGS: At surgery, a cyst was found within the trigone of the left lateral ventricle. The cyst wall was transparent. The cyst was tightly adherent to the choroid plexus. Therapy consisted of puncture of the cyst, partial resection of the cyst wall and opening of the cyst to the frontal and the temporal horn.

ANATOMOPATHOLOGY (IMAGE 10) was consistent with ependymal cyst.

Search also:
Neuroglial (neuro-epithelial) cysts

 

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Fig. 1

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