Intraventricular sizeable colloid cyst with atypical radiological features: A case report and evidence-based review

Colloid cysts are benign intracranial lesions, typically located in the anterior portion of the third ventricle near the interventricular foramina of Monro. The cysts usually consist of an epithelial lining filled with viscous gelatinous material of various components. Colloid cysts are generally asymptomatic, but once symptomatic, they can present in a variety of ways, including headaches, vomiting, visual and memory problems, and vertigo. Colloid cysts present classically on imaging as a well-delineated hyperattenuating lesion on unenhanced radiological modalities. Herein, we report a case of a patient who presented with hydrocephalus caused by a sizeable colloid cyst which demonstrated atypical imaging findings in the form of hypodensity on CT and hyperintensity on T2WI, making them difficult to identify and easy to miss. Although this atypical imaging appearance is uncommon with yet unknown true incidence, it is prudent to be aware of it because early management of colloid cysts has a favorable outcome, in contrast to untreated cysts that are associated with higher rates of morbidity and mortality. Additionally, we provide a comprehensive, evidence-based review of the medical entity of intracranial colloid cysts with highlights of current postulated pathological theories and management algorithms.

Hemolytic uremic syndrome with central nervous system manifestations, a case report and literature review

Hemolytic uremic syndrome (HUS) is a multisystem disorder generally seen in children and young adults, manifesting with the symptomatic triad of thrombocytopenia, hemolytic anemia, and acute kidney injury. These symptoms are often preceded by a prodrome of bloody diarrhea, vomiting, fever, and weakness. HUS is an exceedingly rare entity, with less than 1.5 per 100,000 people affected annually. HUS with central nervous system (CNS) manifestations constitutes approximately 20%-50% of cases and often presents with seizures, altered level of consciousness, and brainstem symptoms. CNS involvement in HUS is a major cause of acute morbidity and mortality; therefore, timely diagnosis and treatment are crucial in the management of these cases. Neuroimaging plays a critical role in the diagnosis; however, it might be very challenging in a large number of cases because studies that report the typical neuroradiologic features of brain injury in cases with HUS are not commonly available. Herein, we demonstrate in a case-based approach, the importance of combining clinical suspicion with different radiologic modalities to better characterize HUS cases with CNS involvement, as well as demonstrate how the early start of meticulous supportive therapy can lead to a favorable outcome even when severe brain involvement is evident on acute imaging studies. Furthermore, we provide an illustrated overview of the current theories that explain the neurologic involvement in HUS, as well as the commonly affected brain areas and how this entity can be radiologically differentiated from other potential diagnoses.

Glioblastoma masquerading as a cystic brain lesion: A case report and evidence-based review

INTRODUCTION AND IMPORTANCE

In adults, glioblastomas account for approximately 12-15 % of primary intracranial neoplasms. In current standard-of-care treatment, glioblastomas have a 5-year survival rate of ~7.5 % and a median survival of ~15 months. Glioblastoma exhibits a highly variable imaging appearance, but the thick and irregular ring enhancement surrounding a necrotic core with infiltrative growth is the most prevalent imaging pattern. Glioblastoma with a cystic component (also known as cystic glioblastoma) is a rare presentation that can be misleading and often mistaken for other cystic brain lesions.

CASE PRESENTATION

In this report, we present a case of a 43-year-old woman who presented to the emergency department with a 2-month history of progressive neurologic manifestations that was attributed to a right-sided cystic brain lesion detected on routine imaging studies, which was later characterized as a cystic glioblastoma based on specific imaging and molecular studies.

CLINICAL DISCUSSION

We highlight the importance of combining radiological and molecular modalities with clinical suspicion for a better characterization of cystic brain lesions and including glioblastoma in the list of potential diagnoses. Furthermore, we provide a comprehensive, evidence-based review of the entity of cystic glioblastoma and how the existence of the cystic component might affect the management and the overall prognosis.

CONCLUSION

Several characteristics make cystic glioblastoma unique. However, it is also capable of mimicking other benign cystic brain lesions, delaying definitive diagnosis and hence the most appropriate management plan.

Spinal dural arteriovenous fistula masquerading as a herniated disc: illustrative case

BACKGROUND

Spinal dural arteriovenous fistula (SDAVF) is a rare disorder with an unknown etiology. Often, the clinical presentation and imaging findings are misleading, causing this condition to be mistaken for other entities, such as demyelinating or degenerative spinal lesions.

OBSERVATIONS

The authors report a challenging case of SDAVF in which the patient's symptoms were initially thought to be attributable to a herniated disc based on his imaging studies at another institution. He sought the authors for a second opinion, which yielded a confirmed diagnosis of SDAVF. Due to his rapidly progressive neurological manifestations, he underwent a surgical division of the fistula using intraoperative video angiography via indocyanine green injections. His symptoms progressively improved over a 3-month period. He regained full sphincter control by 4 months, which gave him a better recovery than seen in other patients with SDAVFs, who do not generally fully regain sphincter control.

LESSONS

SDAVF is a critical spinal vascular pathology that should not be overlooked in the differential diagnosis of any patient presenting with signs of progressive myelopathy. Despite its associated vague initial clinical symptoms, SDAVF typically, but not always, demonstrates a characteristic imaging appearance on magnetic resonance (MR) imaging studies; therefore, MR angiography is still required for definitive diagnosis. Surgical treatment for SDAVF is almost always definitive and curative.