Presentation
Recurrent headaches. Eventually became obtunded at home.
Patient Data
Non contrast CT demonstrates marked hydrocephalus resulting from a large hyperdense lesion at the foramen of Monro. There is poor grey white matter differentiation, and complete effacement of the basal cisterns, with downward (transtentorial) herniation.
At the same time as the initial CT brain a CT angiogram was performed demonstrating no opacification of the intracranial ICA and no opacification of the dural venous sinuses. Note prominent (normal) opacification of the external carotid artery branches in the scalp.
RADIOPHARMACEUTICAL: 99mTc HMPAO, 827 MBq
SPECT/CT studies of the brain were performed.
The initial blood flow studies showed no perfusion into the brain.
Delayed studies show no tracer uptake into the cerebrum, brainstem or cerebellum, all highly consistent with brain death.
Case Discussion
This tragic case highlights the importance of recognizing colloid cysts as a cause of sudden death in young patients.