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Barnicle R, Bracey A, Rosser A, Gordon D. Acute Obstructive Hydrocephalus: An Unexpected Cause of Cardiac Arrest. J Emerg Med 2024; 66:139-143. [PMID: 38228458 DOI: 10.1016/j.jemermed.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/21/2023] [Accepted: 07/15/2023] [Indexed: 01/18/2024]
Abstract
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.
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Affiliation(s)
- Ryan Barnicle
- Department of Emergency Medicine, Brown Emergency Medicine, Providence, Rhode Island
| | - Alexander Bracey
- Department of Emergency Medicine, Albany Medical Center, Albany, New York
| | - Alison Rosser
- Department of Emergency Medicine, Atrium Health Carolinas Medical Center, Charlotte, North Carolina
| | - David Gordon
- Department of Surgical Critical Care, MedStar Health, Washington, District of Columbia
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2
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Montana A, Busardò FP, Tossetta G, Goteri G, Castaldo P, Basile G, Bambagiotti G. Diagnostic Methods in Forensic Pathology: Autoptic Findings and Immunohistochemical Study in Cases of Sudden Death Due to a Colloid Cyst of the Third Ventricle. Diagnostics (Basel) 2024; 14:100. [PMID: 38201409 PMCID: PMC10804246 DOI: 10.3390/diagnostics14010100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
The colloid cyst is a non-malignant tumor growth made of a gelatinous material covered by a membrane of epithelial tissue. It is usually located posterior to the foramen of Monro, in the anterior aspect of the third ventricle of the brain. Due to its location, it can cause obstructive hydrocephalus, increased intracranial pressure, and sudden cardiac death, catecholamine-mediated, through hypothalamus compression. All the mechanisms are still controversial, but the role of catecholamine has been confirmed with histological findings that highlighted myocardial injury (coagulative myocytolysis and contraction band necrosis, CBN). This study presents a case of sudden death in a previously healthy 22-year-old male due to a colloid cyst of the third ventricle. A complete autopsy was performed, highlighting in the brain an abundant quantity of cerebrospinal fluid (CSF) and a 2 cm pale grayish-green rounded cyst formation partially filling and distending the third ventricle. The diagnosis was confirmed through immunohistochemical investigation: positivity for Periodic acid-Schiff (PAS) staining and CK7 expression. In cases such as the one reported here, a combined approach of autopsy, histology, and immunohistochemistry is mandatory in order to identify the neoformation's location and morpho-structural characteristics for a correct differential diagnosis, as well as to identify the cause of death.
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Affiliation(s)
- Angelo Montana
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60126 Ancona, Italy; (A.M.); (G.G.); (P.C.); (G.B.)
| | - Francesco Paolo Busardò
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60126 Ancona, Italy; (A.M.); (G.G.); (P.C.); (G.B.)
| | - Giovanni Tossetta
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, 60126 Ancona, Italy;
| | - Gaia Goteri
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60126 Ancona, Italy; (A.M.); (G.G.); (P.C.); (G.B.)
| | - Pasqualina Castaldo
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60126 Ancona, Italy; (A.M.); (G.G.); (P.C.); (G.B.)
| | - Giuseppe Basile
- Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopedics Institute, 20161 Milano, Italy;
| | - Giulia Bambagiotti
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60126 Ancona, Italy; (A.M.); (G.G.); (P.C.); (G.B.)
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Melicher D, Gaál S, Berényi T, Fenyves BG, Novák PK, Tóth A, Szegedi L, Varga C. Acute hydrocephalus caused by a colloid cyst - a case report. Int J Emerg Med 2023; 16:28. [PMID: 37076791 PMCID: PMC10114300 DOI: 10.1186/s12245-023-00500-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/02/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Colloid cysts are rare benign, slowly growing intracranial tumors of endodermal origin. Most colloid cysts are found incidentally and are asymptomatic, but rarely, they can lead to sudden death. CASE PRESENTATION A 73-year-old female patient was admitted to our emergency department with complaints of dizziness, nausea, vomiting, fatigue, walking difficulties, and behavioral changes. CT imaging revealed acute obstructive hydrocephalus attributable to a third ventricular colloid cyst. The patient was immediately transferred to a tertiary center where she underwent successful neurosurgical resection of the mass. Pathology results of the lesion confirmed the diagnosis of colloid cyst. CONCLUSION The case we present emphasizes the critical importance of prompt identification of warning signs, complex thinking, and evaluation. Establishing the right diagnostic approach early on can facilitate accurate diagnosis.
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Affiliation(s)
- Dóra Melicher
- Department of Emergency Medicine, Semmelweis University, Budapest, Hungary.
| | - Szabolcs Gaál
- Department of Emergency Medicine, Semmelweis University, Budapest, Hungary
| | - Tamás Berényi
- Department of Emergency Medicine, Semmelweis University, Budapest, Hungary
| | - Bánk Gábor Fenyves
- Department of Emergency Medicine, Semmelweis University, Budapest, Hungary
- Department of Molecular Biology, Semmelweis University, Budapest, Hungary
| | - Pál Kaposi Novák
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Ambrus Tóth
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - László Szegedi
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Csaba Varga
- Department of Emergency Medicine, Semmelweis University, Budapest, Hungary
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Alzahrani A, Albouijan A, Alshamsi G, Almanjumi A, Hamdi M, Alteraiqi B, Alshaikhi M. Sudden unexpected death caused by a colloid cyst in the third ventricle: case report. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2023. [DOI: 10.1186/s41935-022-00322-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Abstract
Background
Colloid cysts arise from congenital abnormalities of the endodermis and are characteristically comprised of an external fibrous layer, with a lining of cuboidal and columnar epithelial cells and endodermal ciliated cells. They contain a gelatinous matrix, produced by mucus-producing epithelial cells.
Case presentation
An 8-year-old Saudi girl died in Dammam Central Hospital, to which she was admitted by her parents following her complaints of intense headaches. When the body was examined externally, it was noted that she had bilateral eye congestion, evidence of needle marks on all four limbs and in the region of the femoral triangle and bruising in the central chest and left shoulder areas. No other evidence of injury was noted. A cyst in the third ventricle of the brain was identified at post mortem. Investigations for alcohol, toxins and illicit substances were negative.
Conclusion
It was surmised that the child had died as a result of a cerebral colloid cyst and its clinical sequelae.
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Gibby W, Cvetko S, Gibby A, Gibby C, Sorensen K, Andrews EG, Maroon J, Parr R. The application of augmented reality-based navigation for accurate target acquisition of deep brain sites: advances in neurosurgical guidance. J Neurosurg 2022; 137:489-495. [PMID: 34920422 DOI: 10.3171/2021.9.jns21510] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study is to quantify the navigational accuracy of an advanced augmented reality (AR)-based guidance system for neurological surgery, biopsy, and/or other minimally invasive neurological surgical procedures. METHODS Five burr holes were drilled through a plastic cranium, and 5 optical fiducials (AprilTags) printed with CT-visible ink were placed on the frontal, temporal, and parietal bones of a human skull model. Three 0.5-mm-diameter targets were mounted in the interior of the skull on nylon posts near the level of the tentorium cerebelli and the pituitary fossa. The skull was filled with ballistic gelatin to simulate brain tissue. A CT scan was taken and virtual needle tracts were annotated on the preoperative 3D workstation for the combination of 3 targets and 5 access holes (15 target tracts). The resulting annotated study was uploaded to and launched by VisAR software operating on the HoloLens 2 holographic visor by viewing an encrypted, printed QR code assigned to the study by the preoperative workstation. The DICOM images were converted to 3D holograms and registered to the skull by alignment of the holographic fiducials with the AprilTags attached to the skull. Five volunteers, familiar with the VisAR, used the software/visor combination to navigate an 18-gauge needle/trocar through the series of burr holes to the target, resulting in 70 data points (15 for 4 users and 10 for 1 user). After each attempt the needle was left in the skull, supported by the ballistic gelatin, and a high-resolution CT was taken. Radial error and angle of error were determined using vector coordinates. Summary statistics were calculated individually and collectively. RESULTS The combined angle of error of was 2.30° ± 1.28°. The mean radial error for users was 3.62 ± 1.71 mm. The mean target depth was 85.41 mm. CONCLUSIONS The mean radial error and angle of error with the associated variance measures demonstrates that VisAR navigation may have utility for guiding a small needle to neural lesions, or targets within an accuracy of 3.62 mm. These values are sufficiently accurate for the navigation of many neurological procedures such as ventriculostomy.
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Affiliation(s)
- Wendell Gibby
- 1Department of Radiology, University of California, San Diego, California
- 2Novarad, American Fork, Utah
- 3Blue Rock Medical, Provo, Utah; and
| | | | | | | | | | - Edward G Andrews
- 4Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joseph Maroon
- 4Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Roth J, Perekopaiko Y, Kozyrev DA, Constantini S. Pediatric colloid cysts: a multinational, multicenter study. An IFNE-ISPN-ESPN collaboration. J Neurosurg Pediatr 2022; 29:543-550. [PMID: 35148518 DOI: 10.3171/2021.12.peds21482] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Colloid cysts (CCs) are rare at all ages, and particularly among children. The current literature on pediatric CC is limited, and often included in mixed adult/pediatric series. The goal of this multinational, multicenter study was to combine forces among centers and investigate the clinical course of pediatric CCs. METHODS A multinational, multicenter retrospective study was performed to attain a large sample size, focusing on CC diagnosis in patients younger than 18 years of age. Collected data included clinical presentation, radiological characteristics, treatment, and outcome. RESULTS One hundred thirty-four children with CCs were included. Patient age at diagnosis ranged from 2.4 to 18 years (mean 12.8 ± 3.4 years, median 13.2 years, interquartile range 10.3-15.4 years; 22% were < 10 years of age). Twenty-two cases (16%) were diagnosed incidentally, including 48% of those younger than 10 years of age. Most of the other patients had symptoms related to increased intracranial pressure and hydrocephalus. The average follow-up duration for the entire group was 49.5 ± 45.8 months. Fifty-nine patients were initially followed, of whom 28 were eventually operated on at a mean of 19 ± 32 months later due to cyst growth, increasing hydrocephalus, and/or new symptoms. There was a clear correlation between larger cysts and symptomatology, acuteness of symptoms, hydrocephalus, and need for surgery. Older age was also associated with the need for surgery. One hundred three children (77%) underwent cyst resection, 60% using a purely endoscopic approach. There was 1 death related to acute hydrocephalus at presentation. Ten percent of operated patients had some form of complication, and 7.7% of operated cases required a shunt at some point during follow-up. Functional outcome was good; however, the need for immediate surgery was associated with educational limitations. Twenty operated cases (20%) experienced a recurrence of their CC at a mean of 38 ± 46 months after the primary surgery. The CC recurrence rate was 24% following endoscopic resection and 15% following open resections (p = 0.28). CONCLUSIONS CCs may present in all pediatric age groups, although most that are symptomatic present after the age of 10 years. Incidentally discovered cysts should be closely followed, as many may grow, leading to hydrocephalus and other new symptoms. Presentation of CC may be acute and may cause life-threatening conditions related to hydrocephalus, necessitating urgent treatment. The outcome of treated children with CCs is favorable.
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Affiliation(s)
- Jonathan Roth
- 1Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center; and.,2Tel Aviv University, Tel Aviv, Israel
| | - Yurii Perekopaiko
- 1Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center; and
| | - Danil A Kozyrev
- 1Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center; and
| | - Shlomi Constantini
- 1Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center; and.,2Tel Aviv University, Tel Aviv, Israel
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Bertozzi G, Cafarelli FP, Ferrara M, Di Fazio N, Guglielmi G, Cipolloni L, Manetti F, La Russa R, Fineschi V. Sudden Cardiac Death and Ex-Situ Post-Mortem Cardiac Magnetic Resonance Imaging: A Morphological Study Based on Diagnostic Correlation Methodology. Diagnostics (Basel) 2022; 12:diagnostics12010218. [PMID: 35054385 PMCID: PMC8774558 DOI: 10.3390/diagnostics12010218] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 02/01/2023] Open
Abstract
During the last years, post-mortem imaging has gradually been assumed within research in the field of forensic pathology. This role appears to be clearly and simply applied in the trauma field with the use of conventional radiography or Post Mortem Computed Tomography (PMCT). Recently, particular attention was paid to cardiovascular imaging using Post Mortem Magnetic Resonance Imaging (PMMRI). The present experimental study aims to: (i) confirm the efficacy of a Post Mortem Cardiac Resonance Imaging (PMCRI) study protocol for the study of human hearts collected during the autopsy; (ii) apply the defined protocol on subjects who died of “SCD (sudden cardiac death)”, to identify alterations that could guide subsequent sampling. Two hearts of healthy subjects (A: male 22 years; B: female 26 years), who died from causes other than SCD were collected and compared to hearts that belonged to SCD individuals (C: male, 47 years old; D: female, 44 years old; E: male; 72 years old). The exams were performed on a 1.5 T scanner (Philips Intera Achieva, Best, the Netherlands) on hearts collected during autopsy and after a 30-day formalin fixation. Two readers analyzed the obtained images blindly and after randomization. From the comparison between the data from imaging and the macroscopic and histological investigations carried out, the present study proved the effectiveness of a PMMRI protocol to study ex-situ hearts. Moreover, it suggested the following semeiology in post-mortem SCD cases: the hyperintense area with indistinct margins in the Short Tau Inversion Recovery (STIR) sequence was linked to edema or area of pathological fibers, whereas the hypointense area in the T2-FFE sequences was linked to fibrosis. PMMRI can provide a valuable benefit to post-mortem investigations, helping to distinctly improve the success rate of histological sampling and investigations, which remains the gold standard in the diagnosis of sudden death.
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Affiliation(s)
- Giuseppe Bertozzi
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Francesco Pio Cafarelli
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Michela Ferrara
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.F.); (N.D.F.); (F.M.)
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.F.); (N.D.F.); (F.M.)
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.F.); (N.D.F.); (F.M.)
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (G.B.); (F.P.C.); (G.G.); (L.C.); (R.L.R.)
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.F.); (N.D.F.); (F.M.)
- Correspondence: ; Tel.: +39-06-4991-2722
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Taghipour M, Jamali M, Taherpour S, Safaei N, Rahimi S, Kamran H, Zoghi S, Ghahramani S, Saffarrian A, Taheri R. Letter to the Editor Regarding "Postexercise Death Due to Hemorrhagic Colloid Cyst of Third Ventricle: Case Report and Literature Review". World Neurosurg 2021; 153:149-152. [PMID: 34420773 DOI: 10.1016/j.wneu.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Mousa Taghipour
- Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Jamali
- Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sanaz Taherpour
- Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Negar Safaei
- Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samar Rahimi
- Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Kamran
- Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sina Zoghi
- Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sulmaz Ghahramani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Saffarrian
- Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Taheri
- Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Roberts A, Jackson A, Bangar S, Moussa M. Colloid cyst of the third ventricle. J Am Coll Emerg Physicians Open 2021; 2:e12503. [PMID: 34409403 PMCID: PMC8360874 DOI: 10.1002/emp2.12503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 11/18/2022] Open
Abstract
A colloid cyst is a malformation composed of an amorphous, gelatinous material surrounded by epithelial and connective tissue. It is typically located in the third ventricle, leading to signs of increased intracranial pressure and hydrocephalus. In this case report, we discuss a classic presentation of a patient presenting with a colloid cyst of the third ventricle. This includes the patient's symptoms before arriving at the emergency department and presentation upon arrival and during their hospital stay. We also discuss the diagnostic approach to colloid cysts, providing radiographic imaging to support the diagnosis. Finally, we discuss the approach to treatment of a colloid cyst, including temporizing measures to relieve symptoms and definitive measures for removal of the colloid cyst. The overall approach from diagnosis to management to definitive treatment of a colloid cyst requires an interdisciplinary approach but prompt recognition of the signs and symptoms in the ED can decrease both morbidity and mortality associated with this potentially fatal diagnosis.
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Affiliation(s)
- Alisa Roberts
- The University of Toledo College of Medicine and Life SciencesToledoOhioUSA
- Department of Emergency MedicineThe University of ToledoToledoOhioUSA
| | - Antonio Jackson
- The University of Toledo College of Medicine and Life SciencesToledoOhioUSA
| | - Siddharth Bangar
- Department of Emergency MedicineThe University of ToledoToledoOhioUSA
| | - Mohamad Moussa
- The University of Toledo College of Medicine and Life SciencesToledoOhioUSA
- Department of Emergency MedicineThe University of ToledoToledoOhioUSA
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McCrea HJ, Lara-Reyna J, Perera I, Uribe R, Chotai S, Savage N, Hersh EH, Haussner T, Souweidane MM. Colloid cysts of the third ventricle in children. J Neurosurg Pediatr 2021; 27:700-706. [PMID: 33892476 DOI: 10.3171/2020.10.peds18458] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The rarity of colloid cysts in children makes it difficult to characterize this entity and offer meaningful advice on treatment. Infrequent case reports exist, but to date there has been no age-specific assessment. The purpose of this study was to define any differences between children and adults who are evaluated and treated for colloid cysts of the third ventricle. METHODS Patients with colloid cysts were reviewed and stratified by age. Individuals ≤ 18 years of age were defined as pediatric patients and those > 18 years of age as adults. Clinical and radiographic data, treatment, and postoperative outcomes were compared between both groups. Bivariate analysis was conducted using the Fisher exact test for categorical variables and Mann-Whitney U-test for continuous variables. RESULTS Of 132 endoscopic resections (121 primary, 10 secondary, and 1 tertiary) of a colloid cyst, 9 (6.8%) were performed in pediatric patients (mean age 14.1 years, range 9-18 years) and 123 (93.2%) were performed in adult patients (mean age 43.8 years, range 19-73 years). Cases were found incidentally more commonly in pediatric than adult patients (66.7% vs 37.4%, p > 0.05), and pediatric patients had lower rates of hydrocephalus than adult patients (11.1% vs 63.4%, p < 0.05). Acute decompensation at presentation was found in 8 adults (6.5%) but no children. Complete cyst removal (88.9% vs 90.2%, p > 0.05) and length of stay (1.6 days vs 2.9 days, p > 0.05) were not significantly different between the groups. Postoperative complications (6.5% in adults, 0% in children) and recurrence (2.4% in adults, 0% in children) were rare in both groups, and there were no treatment-related deaths. The mean postoperative radiological follow-up was longer in pediatric patients (45 months, range 4-89 months) than adults (44.1 months, range 1-171 months). CONCLUSIONS While differences exist between children and adults regarding colloid cyst presentation, these are in keeping with the predicted evolution of a slow-growing lesion. Consistent with this observation, children had lower rates of hydrocephalus and a smaller mean maximal cyst diameter. Contrary to the published literature, however, sudden deterioration was not observed in pediatric patients but occurred in adult patients. In this limited pediatric sample size, the authors have not recorded any postoperative complications or recurrences to date. These encouraging results with endoscopic removal may positively impact future decisions related to children given their protracted life expectancy and projected rates of progression.
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Affiliation(s)
- Heather J McCrea
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.,2Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jacques Lara-Reyna
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.,5Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Imali Perera
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Rafael Uribe
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Silky Chotai
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.,3Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicole Savage
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Eliza H Hersh
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Therese Haussner
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Mark M Souweidane
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.,4Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York; and
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11
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Maiellaro A, Perna A, Giugliano P, Esposito M, Vacchiano G. Sudden Death from Primary Cerebral Melanoma: Clinical Signs and Pathological Observations. Healthcare (Basel) 2021; 9:healthcare9030341. [PMID: 33802952 PMCID: PMC8002833 DOI: 10.3390/healthcare9030341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 12/20/2022] Open
Abstract
Primary cerebral tumors rarely provoke sudden death. The incidence is often underestimated with reported frequencies in the range of 0.02 to 2.1% in medicolegal autopsy series. Furthermore, primary cerebral melanoma is an uncommon neoplasm. It represents approximately 1% of all melanoma cases and 0.07% of all brain tumors. This neoplasm is very aggressive, and its annual incidence is about 1 in 10 million people. In the present study, a 20-year-old male was admitted to hospital with vomiting, headache, paresthesia and aggressive behavior. A computed tomography (CT) scan of the head was performed showing a hyperdense nodule in the right parietal lobe with inflammation of the Silvian fissure. A complete autopsy was performed 48 h after death. A blackish material was displayed on the skull base, and posterior fossa. Microscopic examination diagnosed primary brain melanoma. A systematic review of the literature was also performed where no previous analogous cases were found. The forensic pathologist rarely encounters primary cerebral melanoma, and for these reasons, it seemed appropriate to describe this case as presenting aspecific clinical symptoms and leading to sudden unexpected death. Histopathological observations are reported and discussed to explain this surprising sudden death caused by a primary cerebral melanoma.
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Affiliation(s)
- Alfonso Maiellaro
- Legal Medicine Department, A. Cardarelli Hospital, 80131 Naples, Italy;
| | - Antonio Perna
- Pathology Unit, Mauro Scarlato Hospital, 84018 Scafati, Italy;
| | - Pasquale Giugliano
- AORN Sant’Anna e San Sebastiano di Caserta, 81100 San Sebastiano, Italy;
| | - Massimiliano Esposito
- Legal Medicine, Department of Medical, Surgical and Advanced Technologies, “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy
- Correspondence: (M.E.); (G.V.); Tel.: +39-3409348781 (M.E.); +39-3475386107 (G.V.)
| | - Giuseppe Vacchiano
- Department of Law, University of Sannio, 82100 Benevento, Italy
- Correspondence: (M.E.); (G.V.); Tel.: +39-3409348781 (M.E.); +39-3475386107 (G.V.)
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12
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Javalkar V, Amireh A, Kelley RE. Neurological complications of syncope and sudden cardiac arrest. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:189-192. [PMID: 33632438 DOI: 10.1016/b978-0-12-819814-8.00025-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Syncope is very common and usually comes with enough warning for the person to assume a safer position rather than fall in a potentially dangerous way. Syncope may be associated with pregnancy, for example, but we rarely encounter significant injury related to the potential for an associated fall. In the elderly, however, there are often comorbid factors such as delayed reaction time and other aspects of cognitive impairment, along with gait instability, that can affect the defensive reflexes to the point that brain injury, including subdural or epidural hematoma, is not uncommonly encountered. Sudden syncope without warning can also have both neurological and general physical implications in terms of driving safety, safety operating potentially dangerous equipment or exposure to heights as well as the potential impact for drowning or near-drowning while swimming or taking a bath. Sudden death, from whatever the mechanism, implies cerebral hypoperfusion with the potential consequences of hypoxic-ischemic brain injury.
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Affiliation(s)
- Vijayakumar Javalkar
- Department of Neurology, Ochsner/Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - Abdallah Amireh
- Department of Neurology, Ochsner/Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - Roger E Kelley
- Department of Neurology, Ochsner/Louisiana State University Health Sciences Center, Shreveport, LA, United States.
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13
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Ayasa M, Shaikh N, Marcus MAE. A 3rd ventricular colloid cyst causing acute hydrocephalus with stunned myocardium: A case report. Qatar Med J 2020; 2020:28. [PMID: 33282712 PMCID: PMC7684555 DOI: 10.5339/qmj.2020.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/17/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Third ventricular colloid cysts are benign but may cause acute hydrocephalus, raised intracranial pressure, decreased consciousness level, and sudden death. These ventricular colloid cysts associated with stunned myocardium are rarely reported in the literature. This study reported a case of a third ventricular colloid cyst presented as acute hydrocephalus complicated with severe neurogenic pulmonary edema, stunned myocardium, and heart failure, which survived at the end. Case presentation: A 29-year-old woman presented to the emergency department with one day history of headache, vomiting, and altered consciousness level. Early brain imaging showed a cyst in the third ventricle. The patient rapidly deteriorated neurologically and developed severe pulmonary edema and heart failure requiring immediate external ventricular drain and heart failure management. Once stabilized, she underwent endoscopic excision of the ventricular cyst. Histopathology confirmed the diagnosis of colloidal cyst. She survived all these acute life-threatening events, improved, and stabilized, and was discharged home. She was followed up in outpatient clinics after 6 months of discharge with no symptoms or neurological deficit. Conclusion: A third ventricular colloid cyst can cause acute hydrocephalus leading to stunned myocardium requiring immediate surgical intervention, advanced hemodynamic monitoring, and acute heart failure management.
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Affiliation(s)
- Mohammed Ayasa
- Department of Anesthesia, SICU & Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Nissar Shaikh
- Department of Anesthesia, SICU & Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Marco A E Marcus
- Department of Anesthesia, SICU & Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar
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14
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Musa G, Simfukwe K, Gots A, Chmutin G, Chmutin E, Chaurasia B. Clinical and radiological characteristics in fatal third ventricle colloid cyst. Literature review. J Clin Neurosci 2020; 82:52-55. [PMID: 33317739 DOI: 10.1016/j.jocn.2020.10.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/10/2020] [Accepted: 10/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Colloid cysts are a benign tumor that is almost exclusively found in the third ventricle and may cause hydrocephalus and rarely life-threatening acute deterioration and even sudden death. With very few cases of sudden death reported in literature not much is known about the patient and cyst characteristics in these patients. The authors present a review of 65 cases of colloid cyst attributed deaths in literature. MATERIALS AND METHODS A literature search for sudden death with radiologically or pathologically identified colloid cyst was done on PubMed, google scholar, Medbase and clinicaltrials.org research drives. Patient demographics, symptoms and cyst characteristics were recorded and analyzed. A Bivaret Pearson correlationcoefficientwas used to analyze and compare the relationship between each antecedent symptom, cyst size, and, cyst hemorrhage in patients who subsequently succumbed and died in order to ascertain possible relation. RESULTS Most patients had a history of sudden severe headaches (p = 0.01) with associated vomiting (p = 0.03). Radiologically, cyst associated ventriculomegaly was seen in 97% (P = 0.78) was a notable feature. Even more, the cyst size (p = 0.01) and associated hemorrhage (p = 0.02) were also major notable feature preceding sudden death in both gender group. CONCLUSION Acute deterioration in colloid cysts is rare, but can be fatal. Associated symptoms include severe headache and vomiting. Seizures are commonly seen in patients in the first two decades. Given the risk of acute deterioration and mortality, headaches should be thoroughly investigated and all patients diagnosed with a colloid cyst > 1 cm should be offered surgical management regardless of symptom profile.
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Affiliation(s)
- Gerald Musa
- Neurosurgery Resident, Peoples Friendship University of Russia, Russia.
| | - Keith Simfukwe
- Neurosurgery Resident, Peoples Friendship University of Russia, Russia
| | | | | | | | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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15
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Pryce ML, Huo CW, Dawes BH, Chung KHC. Giant colloid cyst occupying a cavum septum pellucidum et vergae. J Clin Neurosci 2020; 80:238-241. [PMID: 33099353 DOI: 10.1016/j.jocn.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 11/18/2022]
Abstract
Colloid cysts are uncommon, intracranial lesions frequently arising from the anterior aspect of the third ventricle. Rarely a cyst presents greater than 30 mm diameter as a giant colloid cyst. This case reports a patient with a giant colloid cyst occupying a cavum septum pellucidum et vergae. The clinical and operative significance of this anatomical variation is discussed and the giant colloid cyst literature reviewed.
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Affiliation(s)
- Mitchell L Pryce
- Department of Neurosurgery, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
| | - Cecilia W Huo
- Department of Neurosurgery, The Alfred, 55 Commercial Road, Melbourne, VIC 3004, Australia.
| | - Bryden H Dawes
- Department of Neurosurgery, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
| | - K H Carlos Chung
- Department of Neurosurgery, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
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16
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Angelopoulou E, Koropouli E, Velonakis G, Koutsis G, Anagnostouli M, Tzartos I, Tzanetakos D, Stranjalis G, Kilidireas C, Evangelopoulos ME. Paroxysmal Lower Limb Tremor as a Rare Presentation of Colloid Cyst of the Third Ventricle: A Case Report and Literature Review. Open Neuroimag J 2020. [DOI: 10.2174/1874440002013010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective:
Colloid cysts of the third ventricle are benign intracranial tumors. They are most commonly presented with signs of intracranial hypertension due to obstructive hydrocephalus, including headache, nausea/vomiting and vision disturbances, whereas extrapyramidal symptoms such as tremor are very rare. Sudden death, due to abruptly developed hydrocephalus, can be also observed. Although paroxysmal symptomatology attributed to the intermittent obstruction of the foramen of Monro is considered the “classical” clinical presentation, it is rather the exception in clinical practice.
Case Report:
A 42-year-old woman with no medical history was admitted to the neurology department as suffering from a potential demyelinating disease due to episodes of paroxysmal tremor of her right lower limb and persistent mild gait instability, which presented 15 days prior to her arrival. She also complained of episodes of partially position-dependent bilateral headache over the last 10 years, as well as episodes of vertigo over the last 4 years. On arrival, her gait was shuffling and mildly wide-based and an intermittent tremor of her right lower limb was observed in supine and sitting positions, but not in a prone position. Brain magnetic resonance imaging (MRI) demonstrated a round cystic lesion of the third ventricle, accompanied by hydrocephalus with enlargement of lateral ventricles. MRI findings were highly indicative of a colloid cyst. The patient underwent resection of the mass and the tremor resolved after surgery.
Conclusion:
Given the greatly heterogeneous clinical presentation of colloid cysts, our case highlights the significance of the prompt diagnosis of this rare but potentially fatal cause of paroxysmal limb tremor.
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Isaacs AM, Bezchlibnyk YB, Dronyk J, Urbaneja G, Yong H, Hamilton MG. Long-Term Outcomes of Endoscopic Third Ventricle Colloid Cyst Resection: Case Series With a Proposed Grading System. Oper Neurosurg (Hagerstown) 2020; 19:134-142. [DOI: 10.1093/ons/opz409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 11/04/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Endoscopic resection of colloid cysts has gained recent widespread practice. However, reported complication and recurrence rates are variable, possibly, in part, because of a lack of consistency with reporting of the extent of cyst capsule removal.
OBJECTIVE
To present the long-term outcomes of endoscopic resection of third ventricle colloid cysts without complete capsule removal and propose a grading system to allow consistent description of surgical outcomes.
METHODS
A retrospective review of 74 patients who underwent endoscopic resection of symptomatic third ventricle colloid cysts between 1995 and 2018 was performed. Kaplan-Meier analyses were used to assess recurrence-free survival rates.
RESULTS
Median patient age and cyst diameter were 48.0 (13.0-80.0) yr and 12.0 (5.0-27.0) mm, respectively. Complete emptying of cyst contents with capsule coagulation was achieved in 73 (98.6%) patients. All patients improved or remained stable postoperatively, with a median follow-up duration of 10.3 (0.3-23.7) yr. Radiographic recurrence occurred in 6 (8.1%) patients after their initial surgery, 5 (6.8%) of whom underwent redo endoscopic resection. No major complications or mortality was encountered at primary or recurrence surgery.
CONCLUSION
Endoscopic resection of third ventricle colloid cysts without emphasizing complete capsule removal is a viable option for successfully treating colloid cysts of the third ventricle. Long-term follow-up demonstrates that it is associated with low risks of complications, morbidity, mortality, and recurrence. The proposed extent of the resection grading scheme will permit comparison between the different surgical approaches and facilitate the establishment of treatment guidelines for colloid cysts.
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Affiliation(s)
- Albert M Isaacs
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri
- Division of Neurosurgery, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Yarema B Bezchlibnyk
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida
| | - Jarred Dronyk
- Division of Neurosurgery, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
- Adult Hydrocephalus Program, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
| | - Geberth Urbaneja
- Division of Neurosurgery, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
- Adult Hydrocephalus Program, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
| | - Heather Yong
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mark G Hamilton
- Division of Neurosurgery, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
- Adult Hydrocephalus Program, Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
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18
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Navigable Channel-Based Trans-Sulcal Resection of Third Ventricular Colloid Cysts: A Multicenter Retrospective Case Series and Review of the Literature. World Neurosurg 2020; 133:e702-e710. [DOI: 10.1016/j.wneu.2019.09.134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 01/16/2023]
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19
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Khan M, Gardezi SA, Nangia V, Jahangir A, Tajik AJ. Giant colloid cyst of the brain masquerading as vasovagal syncope. HeartRhythm Case Rep 2019; 5:314-316. [PMID: 31285988 PMCID: PMC6587043 DOI: 10.1016/j.hrcr.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mohsin Khan
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Syed A Gardezi
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Vikram Nangia
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Arshad Jahangir
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - A Jamil Tajik
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
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20
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Cuoco JA, Rogers CM, Busch CM, Benko MJ, Apfel LS, Elias Z. Postexercise Death Due to Hemorrhagic Colloid Cyst of Third Ventricle: Case Report and Literature Review. World Neurosurg 2019; 123:351-356. [DOI: 10.1016/j.wneu.2018.12.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/06/2023]
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21
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Factors influencing outcome in patients with colloid cysts who present with acute neurological deterioration. J Clin Neurosci 2018; 54:88-95. [DOI: 10.1016/j.jocn.2018.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022]
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22
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Natural history of incidental colloid cysts of the third ventricle: A systematic review. J Clin Neurosci 2018; 53:122-126. [DOI: 10.1016/j.jocn.2018.04.061] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/22/2018] [Indexed: 11/23/2022]
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23
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Heifets BD, Crawford E, Jackson E, Brodt J, Jaffe RA, Burbridge MA. Case Report of an Awake Craniotomy in a Patient With Eisenmenger Syndrome. A A Pract 2018; 10:219-222. [PMID: 29708913 DOI: 10.1213/xaa.0000000000000664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We present a detailed report of an awake craniotomy for recurrent third ventricular colloid cyst in a patient with severe pulmonary arterial hypertension in the setting of Eisenmenger syndrome, performed 6 weeks after we managed the same patient for a more conservative procedure. This patient has a high risk of perioperative mortality and may be particularly susceptible to perioperative hemodynamic changes or fluid shifts. The risks of general anesthesia induction and emergence must be balanced against the risks inherent in an awake craniotomy on a per case basis.
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Affiliation(s)
- Boris D Heifets
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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24
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Li YL, Kwok SKY, Shiu KCK. Colloid cyst and multiple meningiomata in Gorlin syndrome. J Clin Neurosci 2017; 47:157-159. [PMID: 29113850 DOI: 10.1016/j.jocn.2017.10.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/23/2017] [Indexed: 11/15/2022]
Abstract
A middle-aged man presented with syncope and confusion. Neuroimaging revealed a third ventricular mass with obstructive hydrocephalus and bilateral convexity meningiomata. The masses were excised and pathology showed a colloid cyst and WHO grade 1 meningiomata respectively. Multisystem workup confirmed Gorlin syndrome. To our knowledge, this is the fourth reported case of Gorlin syndrome associated with colloid cyst, and the first case where multiple meningiomata are also present.
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Affiliation(s)
- Yan-Lin Li
- Department of Radiology, Queen Mary Hospital, University of Hong Kong, Hong Kong; Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong.
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25
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Lagman C, Rai K, Chung LK, Nagasawa DT, Beckett JS, Tucker AM, Yang I. Fatal Colloid Cysts: A Systematic Review. World Neurosurg 2017; 107:409-415. [PMID: 28801184 DOI: 10.1016/j.wneu.2017.07.183] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/26/2017] [Accepted: 07/29/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To accurately describe patient characteristics and the clinical presentation of fatal colloid cysts. METHODS A systematic literature search of 3 popular databases was performed. Inclusion criteria were individuals with sudden-onset death and colloid cysts identified on imaging and/or autopsy. The cause of death must have been ascribed to the colloid cyst to be eligible for data extraction. Deaths precipitated by lumbar puncture were excluded. Clinical data were extracted and descriptive statistics were ascertained. Subgroup analyses were performed to compare adults with pediatric patients. RESULTS A total of 107 patients were included in the quantitative synthesis. The mean age was 28.5 years (standard deviation 13.3, range 6-79 years). Male and female patients were affected equally. Headache was the most frequent symptom (n = 86, 80%). There were 6 patients (5 adults and 1 child) who reported positional headaches. The mean duration of signs and symptoms was shorter in adults versus pediatric patients (2.1 days vs. 6.5 days, P = 0.02), and more adults presented with signs and symptoms for less than 24 hours than did pediatric patients (38% vs. 6%, P = 0.01). Colloid cyst mean diameter was 2.0 cm (standard deviation 1.1, range 0.5-7.9 cm) and 96% measured 1 cm or larger. CONCLUSIONS Our data suggests that the prodrome preceding sudden death in the setting of a colloid cyst may be shorter in adults. Also, most fatal colloid cysts measured 1 cm or larger.
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Affiliation(s)
- Carlito Lagman
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Kanwaldeep Rai
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Lawrance K Chung
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Daniel T Nagasawa
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Joel S Beckett
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Alexander M Tucker
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, USA; Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, USA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, USA; Department of Neurosurgery, Harbor-UCLA Medical Center, Torrance, California, USA; Los Angeles Biomedical Research Institute (LA BioMed), Harbor-UCLA Medical Center, Torrance, California, USA.
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26
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Microsurgical Treatment of Colloid Cysts of the Third Ventricle. World Neurosurg 2017; 105:678-688. [PMID: 28619498 DOI: 10.1016/j.wneu.2017.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study analyzes the results of surgical treatment in 377 patients with colloid cysts (CCs) of the third ventricle who were treated at the Burdenko Neurosurgery Institute from 1981 to 2015. Operations were performed by a single surgeon (the first author of the article). METHODS The transcallosal approach was used to remove CCs in 97% of cases. Total cyst removal was performed in 96% of cases (in 4% of cases, a small cyst capsule fragment was left on the veins and fornix); in 3 cases, the cyst recurred, which required its repeated removal. RESULTS Hydrocephalus symptoms regressed in 98% of patients. The most frequent complications in the early postoperative period were memory impairments of varying severity, with a tendency to regress by the time of discharge. Two patients had an intraventricular hematoma, which required operative exploration in 1 patient. There were 4 cases of meningitis (including 1 shunt-associated meningitis) and 5 cases of transient pyramidal insufficiency. CONCLUSIONS We made a preliminary assessment of the reasonability of the infratentorial supracerebellar approach for removal of CCs in 10 cases.
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27
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Connolly ID, Johnson E, Lamsam L, Veeravagu A, Ratliff J, Li G. Microsurgical vs. Endoscopic Excision of Colloid Cysts: An Analysis of Complications and Costs Using a Longitudinal Administrative Database. Front Neurol 2017; 8:259. [PMID: 28649225 PMCID: PMC5465269 DOI: 10.3389/fneur.2017.00259] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/22/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Open microsurgical and endoscopic approaches are the two main surgical options for excision of colloid cysts. Controversy remains as to which is superior. Previous studies consist of small cohort sizes. This topic has not been investigated using national administrative claims data which benefits from larger patient numbers. METHODS Current Procedural Terminology (CPT) and International Classification of Disease version 9 (ICD-9) coding at inpatient visit was used to select for index surgical procedures corresponding to microsurgical or endoscopic excision of colloid cysts. Comorbidities, costs, and complications were collected. RESULTS We identified a total of 483 patients. In all, 240 were from the microsurgical cohort and 243 were from the endoscopic cohort. The two groups displayed similar demographic and comorbidity profiles. Thirty-day post-operative complications were also similar between groups with the exception of seizures and thirty-day readmissions, both higher in the open surgical cohort. The seizure rates were 14.7 and 5.4% in the microsurgical and endoscopic cohorts, respectively (p = 0.0011). The thirty-day readmission rates were 17.3 and 9.6% in the microsurgical and endoscopic cohorts, respectively (p = 0.0149). Index admission costs and 90-day post discharge payments were higher in patients receiving microsurgical excision. CONCLUSION An analysis of administrative claims data revealed few differences in surgical complications following colloid cyst excision via microsurgical and endoscopic approaches. Post-operative seizures and thirty-day readmissions were seen at higher frequency in patients who underwent microsurgical resection. Despite similar complication profiles, patients undergoing microsurgical excision experienced higher index admission costs and 90-day aggregated costs suggesting that complications may have been more severe in this group.
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Affiliation(s)
- Ian David Connolly
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Eli Johnson
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Layton Lamsam
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - John Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Gordon Li
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
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28
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Brostigen CS, Meling TR, Marthinsen PB, Scheie D, Aarhus M, Helseth E. Surgical management of colloid cyst of the third ventricle. Acta Neurol Scand 2017; 135:484-487. [PMID: 27349743 DOI: 10.1111/ane.12632] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study of third ventricular colloid cysts (TVCC) from a defined population was to estimate the incidence, the presenting features, the surgical treatment, the treatment related complications, and the clinical and surgical outcomes. METHODS A reprospective study of 32 consecutive primary surgeries for TVCC was performed at Oslo University Hospital in the time period 2002-2015. RESULTS The estimated incidence rate for TVCC was 0.9 per million. Mean age was 41 years and the male-to-female ratio was 1:1.5. The most common presenting symptoms were headache (100%), ataxia (25%), reduced level of consciousness (22%), and impaired vision (19%). The surgical mortality was 0%. Gross total resection (GTR) was achieved in 69% based on intraoperative findings and in 81% based on postoperative imaging. The rate of surgery-related complications was 13%. There was no statistically significant difference between microsurgery and endoscopic surgery with respect to surgery-related complications and grade of resection. At time of follow-up, all patients were able to care for themselves. CONCLUSIONS Due to the risk of acute neurological deterioration and sudden death, surgical treatment is recommended for patients with symptomatic TVCC. This study shows that surgical resection can be performed with a fairly low risk and with a good long-term outcome.
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Affiliation(s)
| | - T. R. Meling
- Faculty of Medicine; University of Oslo; Oslo Norway
- Department of Neurosurgery; Oslo University Hospital; Oslo Norway
| | - P. B. Marthinsen
- Department of Neuroradiology; Oslo University Hospital; Oslo Norway
| | - D. Scheie
- Department of Neuropathology; Oslo University Hospital; Oslo Norway
- Rigshospitalet; Copenhagen Denmark
| | - M. Aarhus
- Department of Neurosurgery; Oslo University Hospital; Oslo Norway
| | - E. Helseth
- Faculty of Medicine; University of Oslo; Oslo Norway
- Department of Neurosurgery; Oslo University Hospital; Oslo Norway
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Sharifi G, Rahmanzadeh R, Lotfinia M, Rahmanzade R. Pilocytic Astrocytoma of Fornix Mimicking a Colloid Cyst: Report of 2 Cases and Review of the Literature. World Neurosurg 2016; 109:31-35. [PMID: 28024978 DOI: 10.1016/j.wneu.2016.12.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Colloid cyst is a gelatin-containing cyst in the brain almost always found in the third ventricle. The specific shape and location of these cysts, a round well-delineated mass in the rostral part of the third ventricle adjacent to the foramen of Monro, on imaging are the main findings for diagnosis. Several masses of the third ventricle masquerading colloid cysts on images have been reported. Based on different surgical approaches, preoperative misdiagnosis of colloid cyst may have great impact on prognosis. METHODS We report 2 cases that presented with severe headache and hydrocephalus, and their preoperative images were highly indicative of colloid cyst. RESULTS Histopathologic investigations after tumor resection showed pilocytic astrocytoma of fornix in both cases. CONCLUSIONS Fifteen cases of colloid cyst misdiagnosis with other masses have been reported thus far; among them, 2 cases were pilocytic astrocytoma. In this study we report 2 other cases. Furthermore, we discuss additional clues helping to differentiate pilocytic astrocytoma from colloid cyst on images.
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Affiliation(s)
- Guive Sharifi
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Rahmanzadeh
- Neuroscience Division, Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Lotfinia
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Rahmanzade
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Agrawal A, Santhi V, Umamaheswara RV. Giant colloid cyst of the third ventricle: challenges in management. Chin Neurosurg J 2016. [DOI: 10.1186/s41016-016-0031-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Byard RW. Variable Presentations of Lethal Colloid Cysts. J Forensic Sci 2016; 61:1538-1540. [DOI: 10.1111/1556-4029.13180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/22/2015] [Accepted: 11/27/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Roger W. Byard
- School of Medicine; The University of Adelaide; Frome Rd Adelaide SA 5005 Australia
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Kone L, Chaichana KL, Rincon-Torroella J, Snyman C, Moghekar A, Quiñones-Hinojosa A. The impact of surgical resection on headache disability and quality of life in patients with colloid cyst. Cephalalgia 2016; 37:442-451. [PMID: 27165491 DOI: 10.1177/0333102416648654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Colloid cysts are histologically benign but can present with a broad spectrum of symptoms. A systematic review of the literature did not reveal any patient-centered data on the headache disability and quality of life (QoL) of these patients. Methods This is a retrospective cohort study of 187 colloid cyst patients from the Colloid Cyst Survival Group who completed a survey that included demographic data, clinical data, a modified QoL survey (SF36v2), and a headache disability inventory or index (HDI). Results Using multivariable linear regressions, we confirmed that the physical (PCS) and mental (MCS) components of SF-36 were significantly increased in the surgery group after adjustment for various baseline characteristics ( p = 0.025; p = 0.006). Self-reported headache disability was significantly decreased with surgery when adjusted for the same baseline characteristics ( p = 0.02). Finally, patients with an incidental diagnosis of colloid cyst reported similar benefits from surgery in PCS, MCS and HDI. Conclusion Our results suggest that colloid cyst patients who underwent a surgical resection self-report a better QoL and less headache disability compared with patients who did not undergo surgery. Future prospective studies with baseline measures of QoL are indicated to confirm our findings.
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Affiliation(s)
- Lyonell Kone
- 1 Department of Neurosurgery, Johns Hopkins University, USA
| | | | | | - Claire Snyman
- 1 Department of Neurosurgery, Johns Hopkins University, USA
| | - Abhay Moghekar
- 2 Department of Neurology, Johns Hopkins University, USA
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Kim SS, Ko SM, Choi SI, Choi BH, Stillman AE. Sudden cardiac death from structural heart diseases in adults: imaging findings with cardiovascular computed tomography and magnetic resonance. Int J Cardiovasc Imaging 2016; 32 Suppl 1:21-43. [PMID: 27139460 DOI: 10.1007/s10554-016-0891-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 02/07/2023]
Abstract
Sudden cardiac death (SCD) is defined as the unexpected natural death from a cardiac cause within an hour of the onset of symptoms in the absence of any other cause. Although such a rapid course of death is mainly attributed to a cardiac arrhythmia, identification of structural heart disease by cardiovascular computed tomography (CCT) and cardiovascular magnetic resonance (CMR) imaging is important to predict the long-term risk of SCD. In adults, SCD most commonly results from coronary artery diseases, coronary artery anomalies, inherited cardiomyopathies, valvular heart diseases, myocarditis, and aortic dissection with coronary artery involvement or acute aortic regurgitation. This review describes the CCT and CMR findings of structural heart diseases related to SCD, which are essential for radiologists to diagnose or predict.
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Affiliation(s)
- Song Soo Kim
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea.
| | - Sang Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| | - Bo Hwa Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Arthur E Stillman
- Department of Radiology, Division of Cardiothoracic Imaging, Emory University Hospital, Atlanta, GA, USA
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Al-Hashel JY, Rady AAH, Soliman DY, Vembu P. Diagnostic Dilemma in a Young Woman with Acute Headache: Delayed Diagnosis of Third Ventricular Colloid Cyst with Hydrocephalus. Case Rep Neurol Med 2015; 2015:180404. [PMID: 26346103 PMCID: PMC4546738 DOI: 10.1155/2015/180404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 06/08/2015] [Accepted: 06/11/2015] [Indexed: 11/28/2022] Open
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.
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Affiliation(s)
- Jasem Y. Al-Hashel
- Department of Neurology, Ibn Sina Hospital, P.O. Box 25427, 13115 Safat, Kuwait
- Department of Medicine, Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110 Safat, Kuwait
| | - Azza A. H. Rady
- Department of Neurology, Ibn Sina Hospital, P.O. Box 25427, 13115 Safat, Kuwait
| | - Doaa Y. Soliman
- Department of Neurology, Ibn Sina Hospital, P.O. Box 25427, 13115 Safat, Kuwait
- Department of Neurology, Cairo University, Egypt
| | - Periasamy Vembu
- Department of Neurology, Ibn Sina Hospital, P.O. Box 25427, 13115 Safat, Kuwait
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M B, W T, Y C, M J, M KS, T M, M BD. Sudden death due to intracranial colloid cyst: About three cases. ACTA ACUST UNITED AC 2015. [DOI: 10.5897/jcpfm2015.0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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36
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Andersen AM, Frost L, Thorup Boel LW. Colloid cysts of the third ventricle at post-mortem CT and at autopsy: A report of two cases. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jofri.2015.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Endoscopic Versus Microsurgical Resection of Colloid Cysts: A Systematic Review and Meta-Analysis of 1278 Patients. World Neurosurg 2014; 82:1187-97. [DOI: 10.1016/j.wneu.2014.06.024] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/11/2014] [Indexed: 11/18/2022]
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Ravnik J, Bunc G, Grcar A, Zunic M, Velnar T. Colloid cysts of the third ventricle exhibit various clinical presentation: a review of three cases. Bosn J Basic Med Sci 2014; 14:132-5. [PMID: 25172970 DOI: 10.17305/bjbms.2014.3.38] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/24/2014] [Indexed: 11/16/2022] Open
Abstract
Colloid cysts are benign intracranial tumours usually occurring in the front part of the third ventricle. Clinical presentation may be non-specific and heterogeneous. The problems are frequently associated with development of hydrocephalus, these cysts may cause. We describe three cases of patients with diverse clinical symptoms, who underwent surgery for colloid cysts of the third ventricle. In the first patient, the colloid cyst caused a sudden deterioration of consciousness due to an acute hydrocephalus. The cyst in the second and third patient was discovered accidentally, during the course of epileptic seizures treatment and due to chronic headache with quanti- and qualitative deterioration of consciousness in the setting of chronic hydrocefalus, respectively. Surgery improved health in all three patients.
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Affiliation(s)
- Janez Ravnik
- University Medical Centre Maribor, Department of Neurosurgery.
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Mecchia D, Casale V, Oneda R, Matturri L, Lavezzi AM. Sudden death of an infant with cardiac, nervous system and genetic involvement--a case report. Diagn Pathol 2013; 8:159. [PMID: 24053176 PMCID: PMC3852348 DOI: 10.1186/1746-1596-8-159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 09/13/2013] [Indexed: 11/29/2022] Open
Abstract
Abstract We present a case of sudden death of a 1-month-old male infant with heart, brainstem and genetic polymorphism involvement. Previously considered quite healthy, the child died suddenly and unexpectedly during sleep. The autopsy protocol included an in-depth anatomopathological examination of both the autonomic nervous system and the cardiac conduction system, and molecular analysis of the serotonin transporter gene promoter region, in which a specific genetic condition seems to be associated with sudden infant death. Histological examination revealed the presence of congenital cardiac alterations (hypertrophic cardiomyopathy and an accessory Mahaim fiber in the cardiac conduction system), severe hypodevelopment of all the raphe nuclei and a heterozygous genotype L/S related to the serotonin transporter gene. The sudden death of this infant was the unavoidable outcome of a complex series of congenital anomalies, each predisposing to SIDS. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3480540091031788
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Affiliation(s)
- Donatella Mecchia
- "Lino Rossi" Research Center for the study and prevention of unexpected perinatal death and SIDS - Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 19, Milan 20122, Italy.
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Riezzo I, Zamparese R, Neri M, De Stefano F, Parente R, Pomara C, Turillazzi E, Ventura F, Fineschi V. Sudden, unexpected death due to glioblastoma: report of three fatal cases and review of the literature. Diagn Pathol 2013; 8:73. [PMID: 23638625 PMCID: PMC3652782 DOI: 10.1186/1746-1596-8-73] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 04/21/2013] [Indexed: 11/10/2022] Open
Abstract
Abstract Sudden death from an undiagnosed primary intracranial neoplasm is an exceptionally rare event, with reported frequencies in the range of 0.02% to 2.1% in medico-legal autopsy series and only 12% of all cases of sudden, unexpected death due to primary intracranial tumors are due to glioblastomas. We present three cases of sudden, unexpected death due to glioblastoma, with different brain localization and expression. A complete methodological forensic approach by means of autopsy, histological and immunohistochemical examinations let us to conclude for an acute central dysregulation caused by glioblastoma and relative complication with rapid increase of intracranial pressure as cause of death. Although modern diagnostic imaging techniques have revolutionized the diagnosis of brain tumors, the autopsy and the careful gross examination and section of the fixed brain (with coronal section) is still the final word in determining exact location, topography, mass effects and histology and secondary damage of brain tumor and contributed the elucidation of the cause of death. Immunohistochemistry and proteomic analysis are mandatory in such cases. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1218574899466985
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Affiliation(s)
- Irene Riezzo
- Department of Forensic Pathology, University of Foggia, Ospedale C, D'Avanzo, viale degli Aviatori, 1, Foggia 71100, Italy
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Neri M, Di Donato S, Maglietta R, Pomara C, Riezzo I, Turillazzi E, Fineschi V. Sudden death as presenting symptom caused by cardiac primary multicentric left ventricle rhabdomyoma, in an 11-month-old baby. An immunohistochemical study. Diagn Pathol 2012. [PMID: 23206573 PMCID: PMC3520811 DOI: 10.1186/1746-1596-7-169] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This case report describes a sudden cardiac death in an apparent healthy 11-month-old infant caused by a multifocal cardiac rhabdomyoma. Parents reported that a few days before the child had fallen to the ground getting a little superficial injury to the scalp. The authors hypothesize that it may have been a transient loss of consciousness episode caused by the cardiac tumour. After the gross examination, histological investigation supported by immunohistochemical analysis using antibody anti- Myoglobin, Actin, Vimentin, Desmin, CD34, S-100, Ki-67 was carried out for the diagnosis. Death was attributed to a multifocal cardiac rhabdomyoma, a benign tumour of striated muscle, which has been completely asymptomatic. In particular, one mass filled the entire posterior wall of the left ventricle. The insidious development of benign cardiac tumours also in infants and children is outlined, focusing on the responsible mechanisms of sudden death in such cases and providing a reference for additional study on these subjects.
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Affiliation(s)
- Margherita Neri
- Department of Forensic Pathology, University of Foggia, Ospedale Colonnello D'Avanzo, Via degli Aviatori 1, Foggia, 71100, Italy
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