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548

Distinctive Pellucidi

CT Appearance

A. Ronald Cowley,1 Dixon M. Eben Alexander, Jr.,2 Marshall D.

Wayne

Laster1

Several

excellent

the

of

accounts

Moody,1 R. Ball,1

of Cyst

of the anatomy

and

pathology

pellucidum and its cysts are available [1 -1 0]. We report a case of a symptomatic

that

produced

obstruction

hydrocephalus.

Follow-up

drainage

tricular

of

are

foramen

studies

also

symptoms

recurrent

the

of

aqueduct

in this

their

and

patient

man

a change

totally

in

before

and the

sensory

a 7 year

remote

initial

history

his

bicycle.

memory

and

admission.

No

or

impairment

abnormalities,

of difficulty

A lifelong

to navigate

unable

recent

had

personality.

cyclist, He

had

one

he

balance become

experienced

syncopal

history

with had

of

of sphincter

control

On

admission,

person,

the

place,

commands

imal metrical

of

in arms

amination

and

films

were of the

demonstrated

the

be seen lateral

riorly,

the

mass

of

The

the

by a mass

Received

lesion

ventricle also

AJR

133:548-550,

level

of Surgery,

dysmetria

was

was

well

span

plexuses.

Repeat

to

cavum

septi

CT

with revealed

persistent

lateral

he

was

his

work.

slight

then

displacement

normal

from

the

status.

examiin lateral

of the

span with

lateral

implanted

reevaluated

confirmed

peritoneal

was

The

Physical decrease

the lateral ventricular freely communicated

to his

lesion

pellucidi.

pellucidum.

of Monro aqueduct.

shunt

the

by excision of of the specimen

septum

system. Partial obstruction of the foramen the third ventricle and kinked the cerebral returned

depression

approach

pneumoencephalography

although large cyst

showed

was effected examination

1 0 months; difficulty

Repeat but

which system.

of Monro.

the

normal

demon-

uneventful.

for

and

normal.

ventricular

patient

ex-

choroid

persistent

was the

decreased ventricular

again distorted A ventriculo-

ventricles

He is employed

and

but

not

the

riding

a bicycle.

left

separated

(figs.

1

anterior

Bowman

Bowman

1979;

Picker Gray

Gray

0361

pellucidi

The

total

1 A).

More

span poste-

of

by

a large

lucent

and

in

after

kinking

revision

this

lieu

flattened

from of the

April

only

ventricle

above

the ward

case

of air

which

cerebral

19,

it was

are

believed

demonstrable

pneumoencephalography.

B and 1 C).

dorsal

accepted

Heretofore,

pellucidum

pneumoencephalography

produced

Discussion

septum

the

septum

(fig.

(CT)

midline

between

8 cm

widely

James

September

tomography

centimeters. was

density

1978;

of the

. Department of Radiology. requests to A. R. Cowley

Department

mm-

sym-

equivocal

no

of the

to be distorted

22.

only

and

Sensory

and

and

leaves

requested

is a fellow

right

Anteriorly

the

were

fluid

which

no

elicited.

Computed

by several

plexuses

September

R. Ball

normal. fornix.

at this

third

revealed

was

hydrocephalus

separated

cerebrospinal

revealed

M

were

neurosurgeons

+2

with was

of irritability

hydrocephalus, by 1 cm. The

to

followed

included

were

testing

A definite

oriented

but

compatible

mass

repeatedly.

ventricles,

choroid

act

deficits

normal.

of the

ventricles

to

Reflexes reflex

skull

lateral

nerve

Cerebellar

shown

and

slow

a Romberg

or columns

of the

cooperative,

was

gaze.

supratentorial

pellucidum could

legs.

entirely

reflex

Plain

lateral

but

was

Babinski

alert,

He

Cranial

right

dyssynergia,

horns

was

situation.

appropriately.

limitation

and

patient

and

drainage Pathologic

convalescence patient

and

of

was along

ventricular

foramen

cyst

was

pellucidum

the

hydrocephalus

obstructed

smooth-walled

as

of the

with

lesion

expanse ventricles

septum

transventricular

and intraventricular of the cyst wall.

nation be

the

a right

reported

puncture of the

region

at the

total

the lateral

to communicate

angle

the

whose

indented

Needle

the

Collapse a portion

The

could

shown

projections,

ventricles

also

2B).

in

a large

because

elicited.

lesion

(fig.

craniotomy

was

seizures,

lateral

confirmed

patients

1 month

headaches,

be

anteropostenior

revealed

deficits

attack

The cyst

venous

At

A 52-year-old

of

not

of the

In

the

walls

Angiography

pro-

Report

and

2B).

a large

could

cedure.

Case

2A).

splayed

medial

strafed

whose

shunting

and

86 mm (fig.

to intraven-

a subsequent

(fig.

cystic

in the cyst

Monro

subsequent

described

required

Septi

and

septum

literature

of the Cavum

are

distinctive

studies.

The

wide

pellucidum,

displacement

cysts

and

of third

of the

cavum

septi

with ventricubography [2] or We feel that the CT features seen and diagnostic of this lesion in

distinctive

hydrocephalus;

septum

that

CT

features

separation

of the

ventricular

of

choroid roof

are the

plexus; (internal

lateral

leaves

of

downcerebral

1979.

Foundation. School

School

of Medicine,

of Medicine,

-803X/79/1

333-0548

Wake

Wake

Forest

Forest

$00.00;

University,

University,

©

American

300

5. Hawthorne

Winston-Salem,

Roentgen

NC

Ray

Rd., Winston-Salem, 27103.

Society

NC 27103.

Adress

reprint

AJR:133,

September

1978

CASE

549

REPORTS

Fig. 1 -A, seltar strafed

CT scan

cistern. by

at level

of supra-

Hydrocephalus dilated temporal

demonhorns

Leaves of septum pelludicum are separated and only seen at this level as they attach

to

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rostrum

of

corpus

collosum

B. Adjacent

(arrow).

scan. Low position of internal cerebral vein (arrow). C. Contrast-enhanced scan. Wide separation of choroid plexus (out!ined arrow). Normally,

they

converge

near

foramen

of

Monro. Cyst had attenuation equal to cerebrospinal fluid. Cyst bounded posteniorly by membrane thought to be hippocampal commissure (arrow).

B Fig.

2.-A,

Erect

frontal

tomogram

midline

(arrows).

veins);

after

limitation

commissure;

lateral

pneumoencephalogram.

cyst puncture

of the and

view

cyst

density

and exchange

posteriorly

of the

Roof

cyst

of third

of cerebrospinal

by the equal

ventricle

These

hippocampal

nicating

to cerebrospinal

fluid. In other

cysts,

fluid-filled

colboid

parasitic septum Prior could

midline

cysts,

cysts

cysts,

as neuroepithelial

velum

cysts, or craniopharyngiomas, pellucidum would not be expected to CT, cause

Dandy similar

bosum.

The

CT findings

of the

corpus

[2] felt only deformity-a

foramen

Dandy’s mographic

of

case

Coronal

and

Monro.

of a ‘ ‘cystic surgical

strated in an article or surgical data are

interpositum,

the leaves of the to be separated.

one other common lesion tumor of the corpus cal-

of a cystic

callosum.

the time of our study) should ular distortion and compression the

such

of the cavum

lesion

rule

CT scans

out solid (not

but

no anatomic

cysts or

amount

of air in left

pellucidum

of the cavum

asymptomatic.

quently

become

lateral

is stretched

large

pellucidi the

Rare

ventricle.

and widely

septi

noncommunicating,

B. Blow-up

displaced

may

former

to

obstruct

be commu-

thought

noncommunicating

enough

from

to

cysts the

be

infre-

foramen

of

Monro as in our case [6]. Dyke and Davidoff [3] found one such lesion in 5000 pneumoencephabograms, and Shaw and Alvord [9] could find only 1 5 symptomatic cases in the world literature prior to 1 969. Heiskanen’s case [6] and this report bring the total to 21 cases. Intraventricular

at

Our case is amazingly similar to Vth ventricle’ ‘ with similar pneufindings. A similar cyst is demon[5],

Small

entirely

tumor

available

demonstrate the third ventricand assess obstruction of

by Harwood-Nash included.

is depressed.

fluid for air. Left leaf of septum

therapy

drainage

of the

cyst

[2, 6, 8]; however,

in our

case,

is generally

resulted and permanent shunting was the symptoms. Heiskanen [6] believes of

other

anomalies

therapeutic.

Our

of case

the did

brain, not

cranial abnormalities. septi pellucidi partially

We believe obstructed

caused

symptoms.

the

recurrent

cyst

demonstrate

only

partial

sufficient collapse

necessary to reduce that in the absence wall

fenestration any

other

is intra-

that a veil of the redundant the foramen of Monro and

550

CASE

REFERENCES

REPORTS

AJR:133,

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cerebral cysts of the cavum septi peland the cavum vergae (sixth ventricle).

Arch Neurol Psychiatry 25:44-66, 1931 2. Dandy WE: The Brain. New York, Harper & Row, 1969 3. Dyke CG, Davidoff LM: The pneumoencephalographic nosis of tumors of the corpus callosum. Bull Neurol Inst 602-623,

4.

1936

Echkernacht their

diagNY 4:

diagnosis

AP, Campbell by

JA: Midline

anomalies

pneumoencephalography.

119-131, 1946 5. Harwood-Nash DC: Congenital

craniocerebral

of the brain: 46:

Radiology

abnormalities.

1979

Semin Roentgenol 1 2:39-51 , 1977 Heiskanen 0: Cyst of the septum pellucidum causing increased intracranial pressure and hydrocephalus. J Neurosurg 38: 771-773, 1973 7. Lowman RM, Shapiro R, Collins LC: The significance of the widened septum pellucidum. AJR 59:177-196, 1948 8. Miller D: Cyst of the fifth ventricle treated by intraventricular drainage. J Neurosurg 6:332-333, 1949 9. Shaw CM, Alvord EC: Cava septi pellucidi et vergae: their normal and pathological states. Brain 92:21 3-224, 1969 1 0. VanWagenen WP, Aind RB: Dilatations of the cavity of the septum pellucidum and cavum vergae. Am J Cancer 20:5396.

1 . Dandy WE: Congenital lucidi (fifth ventricle)

September

557,

1934