British Journal of Neurosurgery, February 2015; 29(1): 110–111 © 2014 The Neurosurgical Foundation ISSN: 0268-8697 print / ISSN 1360-046X online DOI: 10.3109/02688697.2014.957649
SHORT REPORT
Amnesia due to spontaneous haemorrhage into a colloid cyst Ramanan Sivakumaran & Richard J. Edwards
Br J Neurosurg Downloaded from informahealthcare.com by Nyu Medical Center on 06/08/15 For personal use only.
Department of Neurosurgery, Frenchay Hospital, Bristol, UK
Magnetic resonance imaging confirmed a colloid cyst with evidence of acute haemorrhage within it (Fig. 1). He underwent emergency neuro-endoscopic excision of the cyst. Complete removal was achieved and there were no intraoperative complications. The patient’s amnesia completely resolved within 24 h after surgery and he was discharged home 2 days later. Histology confirmed the diagnosis of colloid cyst with evidence of haemorrhage within it (Fig. 2). At follow-up of 2 months post-operatively, he had returned to full-time employment.
Abstract Anterograde amnesia is a recognised complication of colloid cyst excision, occurring usually as a result of forniceal injury. However, spontaneous amnesia due to intra-cyst haemorrhage prior to excision has not been reported previously. We report such a case in which amnesia completely resolved following endoscopic cyst excision. Keywords: amnesia; colloid cyst; excision; haemorrhage
Clinical details Discussion
A 48-year-old man was admitted to our hospital with a 24-h history of anterograde amnesia of abrupt onset, preceded by 4-day history of increasing headache. There was no history of trauma and anticoagulant or anti-platelet use. At the time of presentation to our department, he had complete anterograde amnesia but an otherwise normal neurological examination, with no papilloedema. Plain computed tomography imaging demonstrated a hyperdense third ventricular lesion obstructing the foramina of Monro with hydrocephalus.
Anterograde amnesia is a well-documented complication of injury to the anterior fornix in humans.1,2 The abrupt onset of this patient’s anterograde amnesia was likely to be due to haemorrhage occurring within the cyst, causing a neuropraxic stretch injury to the forniceal fibres. Immediate, complete resolution of anterograde amnesia following surgical colloid cyst excision has not been previously described. This case illustrates that timely surgical excision of colloid cysts
Fig. 1. Axial T2 magnetic resonance imaging scans demonstrating haemorrhage within third ventricular colloid cyst.
Fig. 2. H&E image ( 20) showing columnar epithelium lining colloid cyst (arrow head) and cells within haemorrhage cavity; 10 image (inset) demonstrating collapsed cyst wall with haemorrhage (*).
Correspondence: Ramanan Sivakumaran, Department of Neurosurgery, Southmead Hospital (Department relocated from Frenchay Hospital after time of writing), Bristol, South Gloucestershire BS10 5NB, UK. E-mail: [email protected] Received for publication 19 March 2014; accepted 19 August 2014
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Haemorrhage within a colloid cyst may rapidly improve memory disturbance in addition to treating associated life-threatening hydrocephalus.
Br J Neurosurg Downloaded from informahealthcare.com by Nyu Medical Center on 06/08/15 For personal use only.
Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.
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References 1. Garcia-Bengochea F, Friedman WA . Persistent memory loss following section of the anterior fornix in humans. A historical review. Surg Neurol 1987;27:361–4. 2. Hodges JR, Carpenter K. Anterograde amnesia with fornix damage following removal of IIIrd ventricle colloid cyst. J Neurol Neurosurg Psychiatry 1991;54:633–8.
SHORT REPORT
Amnesia due to spontaneous haemorrhage into a colloid cyst Ramanan Sivakumaran & Richard J. Edwards
Br J Neurosurg Downloaded from informahealthcare.com by Nyu Medical Center on 06/08/15 For personal use only.
Department of Neurosurgery, Frenchay Hospital, Bristol, UK
Magnetic resonance imaging confirmed a colloid cyst with evidence of acute haemorrhage within it (Fig. 1). He underwent emergency neuro-endoscopic excision of the cyst. Complete removal was achieved and there were no intraoperative complications. The patient’s amnesia completely resolved within 24 h after surgery and he was discharged home 2 days later. Histology confirmed the diagnosis of colloid cyst with evidence of haemorrhage within it (Fig. 2). At follow-up of 2 months post-operatively, he had returned to full-time employment.
Abstract Anterograde amnesia is a recognised complication of colloid cyst excision, occurring usually as a result of forniceal injury. However, spontaneous amnesia due to intra-cyst haemorrhage prior to excision has not been reported previously. We report such a case in which amnesia completely resolved following endoscopic cyst excision. Keywords: amnesia; colloid cyst; excision; haemorrhage
Clinical details Discussion
A 48-year-old man was admitted to our hospital with a 24-h history of anterograde amnesia of abrupt onset, preceded by 4-day history of increasing headache. There was no history of trauma and anticoagulant or anti-platelet use. At the time of presentation to our department, he had complete anterograde amnesia but an otherwise normal neurological examination, with no papilloedema. Plain computed tomography imaging demonstrated a hyperdense third ventricular lesion obstructing the foramina of Monro with hydrocephalus.
Anterograde amnesia is a well-documented complication of injury to the anterior fornix in humans.1,2 The abrupt onset of this patient’s anterograde amnesia was likely to be due to haemorrhage occurring within the cyst, causing a neuropraxic stretch injury to the forniceal fibres. Immediate, complete resolution of anterograde amnesia following surgical colloid cyst excision has not been previously described. This case illustrates that timely surgical excision of colloid cysts
Fig. 1. Axial T2 magnetic resonance imaging scans demonstrating haemorrhage within third ventricular colloid cyst.
Fig. 2. H&E image ( 20) showing columnar epithelium lining colloid cyst (arrow head) and cells within haemorrhage cavity; 10 image (inset) demonstrating collapsed cyst wall with haemorrhage (*).
Correspondence: Ramanan Sivakumaran, Department of Neurosurgery, Southmead Hospital (Department relocated from Frenchay Hospital after time of writing), Bristol, South Gloucestershire BS10 5NB, UK. E-mail: [email protected] Received for publication 19 March 2014; accepted 19 August 2014
110
Haemorrhage within a colloid cyst may rapidly improve memory disturbance in addition to treating associated life-threatening hydrocephalus.
Br J Neurosurg Downloaded from informahealthcare.com by Nyu Medical Center on 06/08/15 For personal use only.
Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.
111
References 1. Garcia-Bengochea F, Friedman WA . Persistent memory loss following section of the anterior fornix in humans. A historical review. Surg Neurol 1987;27:361–4. 2. Hodges JR, Carpenter K. Anterograde amnesia with fornix damage following removal of IIIrd ventricle colloid cyst. J Neurol Neurosurg Psychiatry 1991;54:633–8.
