Diagnostic Dilemma in a Young Woman with Acute Headache: Delayed Diagnosis of Third Ventricular Colloid Cyst with Hydrocephalus

Abstract

Objectives. To highlight the importance of early diagnosis of colloid cyst of the third ventricle and its early management. Clinical Presentation and Intervention. This is a young lady who presented with sudden onset headache. She attended a local clinic and also her area hospital. Her diagnosis was delayed several hours due to a diagnostic dilemma initially. No surgical intervention was tried since the patient developed early signs of brainstem coning by the time she was seen by neurosurgeon. Patient died after few days in spite of intensive ICU measures. Conclusion. Sudden onset headache in young adults should be looked at carefully. Early imaging is mandatory to prevent mortality.

Figure 1

Plain axial CT scan of brain-showing severe obstructive lateral ventricle hydrocephalus shown by white arrow with signs of brain edema.

Figure 2

MRI brain FLAIR image axial view showing round shaped mass in the third ventricle, with enlarged both lateral ventricles shown by white arrows.

Figure 3

MRI brain of the same patient, sagittal view showing oval mass in the third ventricle at foramen of Monro, with hydrocephalus shown by arrows.

Figure 4

Mechanism of sudden death of patients with colloid cyst: hypothalamic structures which are involved in cardiovascular control are located close to the walls of the third ventricle which is most frequent anatomical site of the colloid cyst. It is adopted by Turillazzi et al. [4].