Colloid cyst of the third ventricle

Acute Obstructive Hydrocephalus: An Unexpected Cause of Cardiac Arrest

BACKGROUND

Emergency physicians are well-versed in managing cardiac arrests, including the diagnostic and therapeutic steps after return of spontaneous circulation. Neurologic emergencies are a common cause of out-of-hospital cardiac arrest and must remain high in the differential diagnosis, as such cases often require specific interventions that may deviate from more common care pathways. Performing a noncontrast head computed tomography (NCHCT) scan after cardiac arrest has been found to change management, although the optimal timing of this imaging is unclear.

CASE REPORT

This is the case of a young, pregnant woman who presented to the emergency department after cardiac arrest with return of spontaneous circulation in the prehospital setting. She was found to have acute obstructive hydrocephalus on NCHCT, which was later confirmed to be due to a previously undiagnosed colloid cyst of the third ventricle. This acute obstruction resulted in myocardial stunning and, ultimately, cardiac arrest. Although outcomes are often dismal when the cause of arrest is secondary to neurologic catastrophe, this patient survived with completely intact neurologic function. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although acute obstructive hydrocephalus due to a colloid cyst adjacent to the third ventricle is a rare condition, it is a potentially reversible neurologic cause of out-of-hospital cardiac arrest. However, positive outcomes depend on obtaining the diagnosis rapidly with neurologic imaging and advocating for neurosurgical intervention. This case supports the recommendation that emergency physicians should strongly consider post-cardiac arrest neurologic imaging when another cause is not immediately obvious.

Giant Colloid Cyst: A Rare Etiology for Chronic Headache

Chronic headache affects a significant proportion of the population and can be caused by an underlying lesion or a serious condition. This case report describes a 38-year-old male with a history of chronic migraine headaches who presented with syncope. The patient was found to have bilateral papilledema on fundoscopic examination and a well-circumscribed, oval-shaped lesion located within the intraventricular septum on MRI. The lesion was identified as a colloid cyst and was surgically removed through endoscopic transnasal excision. The patient's symptoms improved significantly postoperatively, including the resolution of his chronic headaches and syncope. This case report highlights the importance of considering space-occupying lesions as a possible cause of chronic headaches, particularly when symptoms do not respond to conventional treatments. It demonstrates that an endoscopic transnasal resection is a feasible approach, even for large colloid cysts.