Presentation
Presented to the emergency department with an intensive and progressively growing headache for the last 2 days. There was no impairment in the conscience level. Brain CT and MRI were performed.
Patient Data
Brain CT showed a markedly heterogeneous and complex solid cystic lesion, with a spontaneously dense component that could be calcified or hematic in nature.
The lesion was centrally located and caused obstructive hydrocephalus with asymmetric dilatation of the lateral ventricles. Low-density changes in the surrounding white matter suggested perilesional vasogenic edema.
Brain MRI showed a big heterogeneous mass, solid cystic in appearance, with intralesional calcification foci and hemorrhagic component. Multiple areas of mild diffusion restriction, as well as augmented perfusion and contrast gadolinium enhancement, were noted within the lesion.
The lesion was centrally located and apparently intraventricular in origin, causing obstructive hydrocephalus with asymmetric dilatation of the lateral ventricles. Anterior displacement of the mesencephalic-diencephalic structures together with basal cistern-third ventricle collapse were also noted.
T2-FLAIR hyperintensity changes of the perilesional and periventricular white matter were compatible with both perilesional vasogenic edema or transependymal edema.
Case Discussion
A surgical biopsy of the lesion was taken. Histologic and immunopathologic examination showed low-grade characteristics with neuronal differentiation (synaptophysin and neuronal nuclear antigen were positive), these findings indicating central neurocytoma.