Acute hydrocephalus caused by colloid cyst of third ventricle: A case report

Colloid cysts (CCs) of third ventricle are rare benign lesions. They present with acute hydrocephalus and its sequalae like brain herniation, infarcts resulting even death in otherwise healthy individual. We present a case of an acute hydrocephalus caused by CC of third ventricle. A middle age male was airlifted from a remote district of Nepal to our hospital with no accompanying doctor. The patient had headache, multiple episodes of vomiting, abnormal body movement, and loss of consciousness for 24 hours. On examination, vitals were stable; the Glasgow Coma Scale (GCS) score was 7. The patient was intubated in emergency and an MRI brain was done. MRI showed an obstructive lesion in third ventricle with features consistent with CC and an active hydrocephalus. There were multifocal infarcts in the bilateral cerebrum, left part of mid brain and pons, left thalamus and left superior cerebellum. We inserted external ventricular drainage in emergency operation theatre within hours and endoscopic excision of the lesion was done on the next day. In histopathology, the lesion was confirmed to be a CC.