Presentation
Convulsions.
Patient Data
Right cerebellopontine angle arachnoid cyst is noted reaching 17 mm mildly stretching the inferior aspect of the cisternal portion of the right trigeminal nerve. No related mass effect upon the 7th/8th cranial nerves complex or the other lower cranial nerve.
A (12mm) well-defined right para-sagittal ovoid cystic lesion noted immediately inferior to the frontal horn right lateral ventricle, just anteromedial to the foramen of Monro, showing CSF signal, yet without complete suppression at FLAIR. No diffusion restriction or post-contrast enhancement. No related obstruction of the frontal horn, suggestive of benign cystic lesion (e.g ependymal cyst).
A ring-shaped intraventricular nodule is noted at the frontal horn of the left lateral ventricle, a benign incidental finding.
Another (15mm) well defined cystic lesion noted at the right parietal deep white matter showing pure CSF signal, with complete suppression at FLAIR. No diffusion restriction or post-contrast enhancement. No peri-lesional edema or white matter signal abnormalities. It is surrounded by a cluster of tiny cysts. Features are consistent with enlarged Virchow-Robin spaces.
Case Discussion
This case represents three different types of intracranial cystic lesions.
- right CPA arachnoid cyst. This is most likely incidental finding as no significant mass effect could be noted or presenting complaint related to adjacent cranial nerves
- right perifrontal horn/ benign cystic lesion anterosuperior to the third ventricle, likely ependymal cyst. The most common location of ependymal cysts is the lateral ventricle and can be symptomatic
- right parietal deep white matter benign-looking cystic lesions, representing type II dilated Virchow Robin spaces. Usually, they are an incidental finding
A ring-shaped lateral ventricular nodule is also incidentally noted at the frontal horn of the left lateral ventricle, a benign incidental finding that may be seen on MRI of the brain 1.
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