NEUROLOGY 2008;70:e26
© 2008 American Academy of Neurology
Resident and Fellow Section
Teaching NeuroImage: Prepontine-suprasellar arachnoid cyst presenting with signs of normal pressure hydrocephalus
P. De Bonis, MD,
F. Novegno, MD,
G. Tamburrini, MD,
C. Anile, MD,
A. Pompucci, MD and
A. Mangiola, MD
From the Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
Address correspondence and reprint requests to Dr. Federica Novegno, Institute of Neurosurgery, Catholic University School of Medicine, l.go A. Gemelli, 8 00168 Rome, Italy federicanovegno{at}hotmail.it.
A 64-year-old man was referred to us for suspected normal pressure hydrocephalus (NPH), according to the clinical history of gait disturbance and urge incontinence, and radiologic evidence of a supratentorial hydrocephalus, with enlarged pericephalic spaces (figure 1). A new MRI revealed a 4-cm prepontine arachnoid cyst (figure 2). An endoscopic ventriculo-cystostomy was performed with a prompt improvement of symptoms.
View larger version (64K):
[in this window]
[in a new window]
|
Figure 1 First MRI examination
The first MRI examination revealed the presence of supratentorial ventriculomegaly out of proportion to sulcal atrophy, rounded frontal horns, and transependymal CSF flow in the form of periventricular high signal on T2-weighted FLAIR images.
|
|
View larger version (67K):
[in this window]
[in a new window]
|
Figure 2 T2-weighted images
(A, B) Preoperative T2-weighted images revealing a space-occupying suprasellar prepontine arachnoid cyst (arrows), displacing superiorly the third ventricle floor, the pituitary stalk and the optic chiasm, and, posteriorly, the mammillary bodies. (C, D) Postoperative T2-weighted images demon-strating a more horizontal orientation of chiasm and third ventricle floor. The cyst has shrunk (arrows).
|
|
Eighty-five percent of prepontine arachnoid cysts occur in children; most of them present with acute/subacute signs of increased intracranial pressure. The possibility of diagnosing these lesions in adults has been reported; only two cases have been described in the elderly, none of whom had symptoms of NPH.1,2
 |
ACKNOWLEDGMENT
|
|---|
The authors thank Daniele Petricca for help with illustrations.
Disclosure: The authors report no conflicts of interest.
|
REFERENCES
|
|---|
- Kandogan T, Olgun L, Gultekin G, Aydar L, Sezgin O. A suprasellar arachnoid cyst destructing sphenoid sinus: an unusual cause of headache in an elderly female. Swiss Med Wkly 2004;134:28–29.[Medline]
- Thompson TP, Levy EI, Jho HD, Lunsford LD. Primum non nocere: multimodality management strategies when multiple mass lesions strike a single patient. Surg Neurol 2001;55:332–339.[Medline]
Top.
ACKNOWLEDGMENT
REFERENCES
