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Neuropediatrics
DOI: 10.1055/s-0043-1778648
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Colloid Cyst Causing Massive Headache Attacks

Malin Zaddach 
1   LMU University Hospital Munich, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
,
Johanna Wagner
2   LMU University Hospital, Division of Paediatric Neurology and Developmental Medicine - MUC Munich University Center for Children with Medical and Developmental Complexity, Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
,
Mathias Kunz
3   LMU University Hospital Munich, Department of Neurosurgery, Ludwig Maximilians University, Munich, Germany
,
Marco Paolini
4   LMU University Hopsital, Munich, Department of Radiology, Ludwig Maximilian University, Munich, Germany
,
Ingo Borggraefe
5   LMU University Hospital, Division of Pediatric Neurology and Developmental Medicine and Epilepsy Center, Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
,
Florian Heinen
2   LMU University Hospital, Division of Paediatric Neurology and Developmental Medicine - MUC Munich University Center for Children with Medical and Developmental Complexity, Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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A 12-year-old boy presented with acute onset of unilateral headache preceded by 3 days of holocephal headache. His medical history was not remarkable, and clinical examination was without any significant findings. Headache episodes recurred with increasing intensity twice per day in a stringent circadian rhythm. While in pain the patient showed nonresponsiveness, tachypnea, and partial hallucinations. Analgesic treatment (including opiates and indomethacin) and high-flow oxygen inhalation remained without effect. Brain magnetic resonance imaging revealed a 9-mm lesion in the roof of the third ventricle. After total surgical excision of the lesion (histopathological: colloid cyst) via a left frontal access, our patient experienced immediate symptom relief. Colloid cysts are columnar epithelium-lined cysts, which originate from abnormal folding of the neuroepithelium.[1] Although benign, location in proximity to the foramen of Monro can lead to liquor flow obstruction, causing obstructive hydrocephalus and symptoms such as thunderclap headache, vomiting, unconsciousness, or even sudden death.[2] [3] On the last follow-up, our patient was symptom free ([Fig. 1]).

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Fig. 1 Magnetic resonance imaging of the brain showing noncontrast enhanced cystic lesion (indicated by arrows) in the area of foramen of Monro (marginal contrast enhancement most likely caused by nearby vessel). Left: coronal plane (fluid-attenuated inversion recovery). Right: axial plane (T1-weighted image contrast enhanced).


Publication History

Received: 12 October 2022

Accepted: 07 December 2023

Article published online:
05 February 2024

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