Unexpected death from a colloid cyst
© Springer-Verlag London Ltd 2010
Received: 17 August 2009
Accepted: 3 December 2009
Published: 27 February 2010
Colloid cysts are usually benign brain tumors, which rarely cause acute neurological deterioration with sudden death due to an acute increase of intracranial pressure. So far, the final pathophysiology and clinical signs of impending death are unclear in this context.
We present a case of an adolescent who presented with symptoms similar to gastroenteritis.
He unexpectedly developed a generalized seizure, acute pulmonary edema and life-threatening cardiac dysrhythmia.
Subtle distinctions between symptoms due to intracranial hypertension, which typically cause headache and vomiting, and true gastroenteritis are discussed as well as the pathophysiology of neurogenic pulmonary edema and the origin of cerebral-triggered cardiac dysrhythmias.
A previously healthy adolescent male presented with a 3-day history of headache and vomiting, initially diagnosed as gastroenteritis. On the day of admission, he presented with slightly lethargy, but was able to communicate and follow simple commands. Unexpectedly, he developed a generalized seizure and different types of unstable tachycardia. Multiple cardioversions and amiodarone finally resulted in sinus tachycardia. Sudden pulmonary edema required intubation, and a few minutes later, the pupils became dilated and fixed. An immediate CT scan showed a hyperdense colloid cyst in the foramen of Monro with massive hydrocephalus. A chest x-ray showed a picture of a white lung similar to ARDS. A bilateral ventricular external shunt performed by neurosurgeons was of no avail; the patient died after 2 days decerebrated. No post-mortem examination was performed.
Third ventricular colloid cysts can affect young patients and often present with mild symptoms . Diagnosed in a timely manner, these ependymomas can easily be removed by neurosurgeons. A delay in diagnosis can lead to an acute clinical deterioration with unexpected and sudden death [2–4]. The diagnosis of a viral illness is the typical pitfall. Cardiac and pulmonary complications can accompany brain herniation and again distract physicians from the underlying cerebral origin [5–8].
Colloid cysts, although rare, should remain in the differential diagnosis in young patients with headache and vomiting—especially if no further symptoms are present. Immediate diagnostic testing in suscpected cases is essential since an acute hydrocephalus can be disastrous within minutes. There was no positive family history in this case, but familial clusters have been described [9–11].
- Elgamal EA, Richards PG (2006) Sudden death in children due to intracranial mass lesion. Childs Nerv Syst 22(3):305–309PubMedView ArticleGoogle Scholar
- Humphries RL, Stone CK, Bowers RC (2008) Colloid cyst: A case report and literature review of a rare but deadly condition. J Emerg MedGoogle Scholar
- Opeskin K, Anderson RM (1995) Colloid cysts of the third ventricle: fatal outcomes associated with unusual presentation. J Clin Neurosci 2(4):307–311PubMedView ArticleGoogle Scholar
- Shemie S et al (1997) Acute obstructive hydrocephalus and sudden death in children. Ann Emerg Med 29(4):524–528PubMedView ArticleGoogle Scholar
- Baumann A et al (2007) Neurogenic pulmonary edema. Acta Anaesthesiol Scand 51(4):447–455PubMedView ArticleGoogle Scholar
- Bunai Y et al (2008) Sudden death due to undiagnosed intracranial hemangiopericytoma. Am J Forensic Med Pathol 29(2):170–172PubMedView ArticleGoogle Scholar
- Grosse-Wortmann L, Bindl L, Seghaye MC (2006) Multiple types of cardiac arrhythmias in a child with head injury and raised intracranial pressure. Pediatr Cardiol 27(2):286–288PubMedView ArticleGoogle Scholar
- Sedy J et al (2008) Mechanisms of neurogenic pulmonary edema development. Physiol Res 57(4):499–506PubMedGoogle Scholar
- Akins PT et al (1996) Familial colloid cyst of the third ventricle: case report and review of associated conditions. Neurosurgery 38(2):392–395PubMedView ArticleGoogle Scholar
- Socin HV et al (2002) Familial colloid cyst of the third ventricle: neuroendocrinological follow-up and review of the literature. Clin Neurol Neurosurg 104(4):367–370PubMedView ArticleGoogle Scholar
- Stoodley MA, Nguyen TP, Robbins P (1999) Familial fatal and near-fatal third ventricle colloid cysts. Aust NZ J Surg 69(10):733–736View ArticleGoogle Scholar