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February 05, 2008; 70 (6) Resident and Fellow Section

Teaching NeuroImage: Prepontine-suprasellar arachnoid cyst presenting with signs of normal pressure hydrocephalus

P. De Bonis, F. Novegno, G. Tamburrini, C. Anile, A. Pompucci, A. Mangiola
First published February 4, 2008, DOI: https://doi.org/10.1212/01.wnl.0000296823.01603.44
P. De Bonis
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Teaching NeuroImage: Prepontine-suprasellar arachnoid cyst presenting with signs of normal pressure hydrocephalus
P. De Bonis, F. Novegno, G. Tamburrini, C. Anile, A. Pompucci, A. Mangiola
Neurology Feb 2008, 70 (6) e26; DOI: 10.1212/01.wnl.0000296823.01603.44

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A 64-year-old man was referred to us for suspected normal pressure hydrocephalus (NPH), according to the clinical history of gait disturbance and urge incontinence, and radiologic evidence of a supratentorial hydrocephalus, with enlarged pericephalic spaces (figure 1). A new MRI revealed a 4-cm prepontine arachnoid cyst (figure 2). An endoscopic ventriculo-cystostomy was performed with a prompt improvement of symptoms.

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Figure 1 First MRI examination

The first MRI examination revealed the presence of supratentorial ventriculomegaly out of proportion to sulcal atrophy, rounded frontal horns, and transependymal CSF flow in the form of periventricular high signal on T2-weighted FLAIR images.

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Figure 2 T2-weighted images

(A, B) Preoperative T2-weighted images revealing a space-occupying suprasellar prepontine arachnoid cyst (arrows), displacing superiorly the third ventricle floor, the pituitary stalk and the optic chiasm, and, posteriorly, the mammillary bodies. (C, D) Postoperative T2-weighted images demon-strating a more horizontal orientation of chiasm and third ventricle floor. The cyst has shrunk (arrows).

Eighty-five percent of prepontine arachnoid cysts occur in children; most of them present with acute/subacute signs of increased intracranial pressure. The possibility of diagnosing these lesions in adults has been reported; only two cases have been described in the elderly, none of whom had symptoms of NPH.1,2

ACKNOWLEDGMENT

The authors thank Daniele Petricca for help with illustrations.

Footnotes

  • Disclosure: The authors report no conflicts of interest.

  • Series editor: Mitchell S.V. Elkind MD, MS, Section Editor

REFERENCES

  1. 1.↵
    Kandogan T, Olgun L, Gultekin G, Aydar L, Sezgin O. A suprasellar arachnoid cyst destructing sphenoid sinus: an unusual cause of headache in an elderly female. Swiss Med Wkly 2004;134:28–29.
    OpenUrlPubMed
  2. 2.
    Thompson TP, Levy EI, Jho HD, Lunsford LD. Primum non nocere: multimodality management strategies when multiple mass lesions strike a single patient. Surg Neurol 2001;55:332–339.
    OpenUrlPubMed
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