Symptomatic Cerebral Ependymal Cyst : A Case Report

@#Cerebral ependymal cyst is a rare benign neuroepithelial cyst. We report a case of cerebral ependymal cyst in a 62-year-old lady who presented with status epilepticus. She gave history of progressive right occipital headache over a year. Magnetic Resonance Imaging of the brain showed a large occipital cyst. She underwent a right craniotomy, deroofing of the cyst and insertion of Ommaya catheter. The clinicopathological aspects of the cyst are discussed.

Hallazgo de quiste ependimario (ependimoma) intramedular en el estudio de la vía piramidal y síndrome siringomiélico / Finding of intramedullary ependymal cyst (Ependymoma) in the study of pyramidal tract and syringomyelic syndrome

Introducción: Una paresia tiene que ser objeto de un detallado análisis para conocer su correcta etiología. La exploración física debe incluir una minuciosa valoración neurológica que oriente la localización de la lesión. Caso Clínico: Paciente con paresia de extremidad inferior derecha, hiperreflexia, clonus y disminución de sensibilidad térmica y algésica por debajo de la apófisis xifoides. Estos hallazgos señalan a nivel vertebral dorsal, D8, posible localización de una lesión que afecta a la vía piramidal motora y la vía sensitiva. La sospecha clínica se confirma mediante RMN que mostró la presencia de masa intramedular, posible ependimoma. Conclusiones: El conocimiento de la anatomía de los haces nerviosos que discurren por la médula espinal y la información nerviosa que proporcionan, contienen signos clínicos motores y sensitivos que permiten discernir qué haces nerviosos están lesionados. Este juicio clínico puede dirigir, de manera mucho más concreta, hacia el tipo de exploraciones y pruebas complementarias que pueden ser necesarias para concretar un diagnóstico y reducir el gasto sanitario, así como el tiempo de espera para un posible tratamiento quirúrgico(AU)

Introduction: A paresis must be the object of a detailed analysis to know its correct etiology. Physical examination should include a thorough neurological assessment to guide the location of the lesion. Clinical case: Patient with paresis of the lower right extremity, hyperreflexia, clonus, and decreased thermal and algic sensitivity below the xiphoid process is preseneted. These findings point to the dorsal vertebral level, D8, possible location of a lesion that affects the pyramidal motor pathway and the sensory pathway. Clinical suspicion is confirmed by MRI that showed the presence of intramedullary mass, possible ependymoma. Conclusions: The knowledge of the anatomy of the nerve bundles that run through the spinal cord, and the nerve information they provide contain clinical and sensory clinical signs, allowing to discern which nerve bundles are injured. This clinical judgment can lead, in a much more concrete way, to the type of explorations and complementary tests that may be necessary to diagnose and reduce health costs, as well as the waiting time for a possible surgical treatment(AU)

An Ependymal Cyst in Cerebello-Pontine Angle Presenting with Syncope

Intracranial ependymal cysts are rare, congenital, benign lesions. These commonly occur in the supratentorial regions and usually generate no symptoms. The cerebellopontine angle (CPA) is an extremely rare site for ependymal cysts. Furthermore, there are no previous reports of CPA ependymal cysts related to syncope. We report a case of ependymal cyst in the left CPA with syncope. The patient underwent a cardiologic evaluation for syncope after admission, but there were no definite cardiologic abnormal findings. He underwent fenestration into the subarachnoid space, and the pathologic diagnosis revealed an ependymal cyst. We analyzed this case with review of other literatures.

Spinal Intramedullary Ependymal Cysts : A Case Report and Review of the Literature

We report a rare case of a spinal intramedullary ependymal cyst in a 46-year-old female and review the 17 pathologically proven cases in the literature. The patient presented with a two-week history of gradually increasing tingling in her left posterior thigh and calf. A preoperative magnetic resonance image revealed a well-defined intramedullary cystic lesion on the ventral side of the spinal cord at the T11 to T12 levels. The lesion was hyper intense in T2-weighted images and hypointense in T1-weighted. The patient underwent a right-side hemilaminectomy at the T11 to T12 levels and fenestration of the cyst wall. After having the cyst wall partially removed and communication established between the cyst and the subarachnoid space, the patient improved neurologically. A histological study of the surgical specimens revealed that the cyst wall consisted of glial cells lined by a simple cuboidal to columnar epithelium. An immunohistochemical examination of the cells lining the cyst wall was positive for S-100 protein, glial fibrillary acidic protein, epithelial membrane antigen, and cytokeratin. We suggest that the optimal treatment of intramedullary ependymal cysts creates adequate communication between the cyst and the subarachnoid space.

Progressively Enlarged Intracerebral Ependymal Cyst Presenting with Movement Disorder

Ependymal cysts are neuroepithelial cysts, typically found in the central white matter of the temporoparietal and frontal lobes. Clinical symptoms usually result from neurological deficits referable to these regions, from seizures, and chronic headaches associated with increased intracranial pressure. We describe here a case of ependymal cyst on the right fronto-parietal lobe, presenting with tremor and weakness. The cyst was resected surgically and presurgical neurological abnormalities were improved. An exploratory surgery with establishment of an adequate route of drainage and histological examination of the cyst wall are mandatory in the management of patients with a progressive and symptomatic intraparenchymal cyst.

Spinal Intramedullary Ependymal Cyst

The authors report a case of intramedullary ependymal cyst at the level of conus medullares in 44-year-old man. The patient was admitted to our hospital due to progressing both lower extremities weakness and radiating pain for 6months. Magnetic resonance(MR) imaging showed intramedullary cystic mass at the level of conus which compressed spinal cord. The patient underwent partial removal and made cyst to communicate with subarachnoid space. The histologic finding was ependymal cell cyst. After surgery the patient had symptomatic improvement and in follow-up MR image cyst regressed in size.

Ependymal Cysts

The authors report four cases of ependymal cysts. Among the benign cystic lesions of neuroepithelial origin, ependymal cysts have been reportedly located in the cerebral parenchyme. This usually become symptomatic after 40 years of age, although it is generally thought to be congenital in origin. Symptomatic cases have been treated effectively with resection of the cyst or shunting procedures. Stereotactic removal of the cyst was also a good alternative as management in the authors' cases. Differential diagnosis is mandatory with other benign intraparenchymal cystic diseases.

Ependymal Cyst of the Sylvian Fissure

Cerebral ependymal cysts are very rare. About 30 cases have been reported in the literature. They mimic arachnoid cysts clinically and on imaging studies but are different from arachnoid cysts in pathological findings. They are believed to arise by the sequestration of a small segment of the primitive ependymal lining into either the cortical mantle or the perimedullary mesh. They occupy the central white matter of the frontal or temporoparietal lobes. The authors describe a case of septate ependymal cyst involving left sylvian fissure. The clinicopathological features, treatment, and results of previously reported cases are reviewed, and the etiology and pathogenesis of these cysts are discussed.

A Case of Ependymal Cyst

Ependymal cysts are rare entities that have evoked much controversies regarding their pathogenesis. We report a case of an intracerebral ependymal cyst associated with periventricular heterotopia and microgyria in a 16-year-old girl who was admitted in our institution for evaluation of a 4-year history of seizure. Neurological examination revealed nothing remarkable. Brain magnetic resonance imaging(MRI) showed a cystic mass in the right temporal lobe communicating with the posterior horn of the lateral ventricle by a narrow fistula. Also, Periventricular heterotopia and microgyria of the right cerebral hemisphere were also seen. A right temporal lobectomy that included complete exision of the cyst was performed;during surgery, the fistula connecting the cyst with the lateral ventricle was noted in the posterior temporal lobe. Microscpic examination of the specimen confirmed that the lining of the cyst consisted of simple, ciliated cuboidal epithelium that was similar to that in an ependyma and the lining showed no basement membrane. Adjacent to the cyst, heterotopic gray matter was seen and the cortex of the temporal lobe showed ischemic changes. Postoperatively, the patient made unremarkable recovery except for intermittent episodes of seizure. The clinicopathological features, radiological findings and surgical treatments are discussed in the context of the literature.

Ependymal Cyst: A Case Report

The authors report a case of a large symptomatic ependymal cyst in a 3-year-old boy not in communication with the subarachnoid space or the ventricular system, resulting in compression of the lateral ventricle and the surrounduing structures. Computerized tormography(CT) of the boy who complained of intermittent headache since a year ago revealed a large-sized, low density mass at the left parieto-occipital region of the brain. The cyst was totally removed, and histopathological study of the evacuated mass showed that the cyst wall was composed of ciliated columnar and cuboidal epithelium with thin collagenous membrane. Postoperatively, the patient recovered unremarkably with no neurological deficits and was discharged with complete relieval of his symptoms. The histogensis and the histopathological features are discurssed in the context of the review of the literature.

Cystic Meningioma: A case report

Meningiomas are usually thought of as firm solid tumors and most standard references make no mention of cystic meningiomas. Although several cases of cystic meningioma have been reported in the literature and their neuroradiological features discussed, the rarity of this entity makes its preoperative diagnosis difficult. Recently, the authors encountered a case of cystic meningioma, which was thought as ependymal cyst or infarction, preoperatively. In this report the authors discussed its clinical, neuroradiological and pathological characteristics with brief reviews of the literature.

Ependymal Cyst: A Case Report

The authors present a case of intracerebral ependymal cyst involving the left parietal lobe. The cyst had no communication with ventricular system or subarachnoid space. The clinicopathological features, radiological findings and surgical treatments are discussed including a review of literatures.

A Case of Ependymal Cyst

A case of intracerebral ependymal(neuroepithelial) cyst of developmental origin is presented. The cyst had no communication with ventricular system or subarachnoid space. The protein content of cyst fluid was higher than that of the CSF. The preoperative, postoperative CT scan and operative findings are presented. The authors reviewed and discussed the previously reported cases. .