Suprasellar arachnoid cyst presenting with bobble-head doll syndrome: Report of three cases

Abstract

Suprasellar arachnoid cysts can have varied presentations with signs and symptoms of obstructive hydrocephalus, visual impairment, endocrinal dysfunction, gait ataxia and rarely bobble-head doll movement. The bobble-head doll movement is a rare movement disorder characterized by antero-posterior bobbling of the head and neck on the trunk every 2-3 seconds. We present three cases with bobble-head doll syndrome associated with a large suprasellar arachnoid cyst and obstructive hydrocephalus, which were treated with endoscopic cystoventriculocisternostomy and marsupialization of the cyst.

Keywords: Bobble-head doll syndrome; endoscopic cystoventriculocisternostomy; hydrocephalus; suprasellar arachnoid cyst.

Figure 1

T1-weighted images coronal: Well-defined cerebrospinal fluid signal intensity in prepontine, interpeduncular, suprasellar, anterior third ventricle with dilatation of third and both lateral ventricles

Figure 2

T1-weighted images axial: Well-marginated cerebrospinal fluid signal intensity cystic lesion in prepontine, interpeduncular, suprasellar, anterior third ventricle with moderate dilatation of third and both lateral ventricles

Figure 3

T1-weighted image axial: Ventricular dilatation has significantly decreased with near normal size ventricles

Figure 4

T2 sagittal: Gross dilatation of body of lateral and third ventricle with fenestrations of cyst at superior and inferior aspect

Figure 5

Cyst bulging into foramen of monro

Figure 6

Thinned out third ventricular floor

Figure 7

Computed tomography scan: Cerebrospinal fluid cystic lesion noted in suprasellar, prepontine, interpendicular, third ventricle with moderate obstructive hydrocephalus. Normal fourth ventricle

Figure 8

Minimal decrease in cerebrospinal fluid density cystic lesion and obstructive hydrocephalus