Blindness : An Uncommon Presentation of Colloid Cysts = العمى : عرض إستثنائي لتكيسات غروانية

Abstract

Colloid cysts may obstruct the foramina of Monro and lead to acute hydrocephalus.1,2 In patients with colloid cysts, intraventricular pressure can increase suddenly due to acute obstructive hydrocephalus.3,4 A sudden and dramatic rise in ventricular pressure may lead to cerebral herniation, infarction and may result in death.4 These images show a patient who was admitted to Ataturk Training and Research Hospital, Ankara, Turkey, with complaints of visual loss. Acute bilateral blindness is an emergent condition that may signal a life-threatening disease. A 46-year-old man with no previous neurological complaints was admitted to our hospital with symptoms of headache, loss of consciousness and the progressive loss of vision. A physical examination revealed less than 20/20 central visual acuity. Moderate hydrocephalus and bilateral periventricular oedema were detected by a computed tomography (CT) scan performed in the Emergency Department [Figure 1]. Magnetic resonance (MR) imaging and diffusion-weighted imaging (DWI) were recommended for the patient, as the aetiology of hydrocephalus could not be determined exactly by the initial CT scan. On MR imaging, a colloid cyst and acute hydrocephalus were detected. In addition, diffusion-weighted imaging (DWI) revealed areas with restricted diffusion on the bilateral occipital lobes. As a result of these findings, ventriculoperitoneal shunting was performed five hours after the patient was admitted. MR images were obtained after the procedure, which detected regression in the sizes of the lateral ventricles and in the periventricular cerebrospinal fluid reabsorption [Figure 1]. In addition, there were infarctions in the bilateral occipital lobes and no recovery of vision. The posterior circulation was normal and there were early subacute infarctions in the occipital lobes on the MR images taken one week after the shunt therapy. There was no improvement in the loss of vision of the patient at the second week follow-up. Figure 1 A–K: Preoperative computed tomography (CT) and postoperative magnetic resonance (MR) images of the patient. A, B & C: Preoperative sequential axial CT images showing hydrocephalus and periventricular oedema. D, E, F & G: Postoperative axial ...