The large midbrain cyst
Headaches, mental confusion
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Thin-walled cystic lesion within a right part of the midbrain without perifocal oedema causing aqueductal compression and triventricular hydrocephalus (Vt up to 14mm), no transependymal imbibition.
Convexital arachnoid spaces narrowing.
Multiple multiform T2 hyperintense foci at the periventricular white matter.
No diffusion restriction.
Cystic signal characteristics on ADC maps due to T2 shine through effect.
This big cyst located in the right midbrain can be a neuroglial cyst as well as giant dilated perivascular space, despite there is only one neurosurgical tactic - shunting surgery: 3rd ventriculocisternostomy or ventriculoperitoneal shunting.