Acute Hydrocephalus from Translocated Subependymoma
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Acute Hydrocephalus from Translocated Subependymoma Sahar Soleimani1
· Katelynn Davis2 · Nisha Sankaran1 · Nafi Aygun1
Received: 1 June 2020 / Accepted: 7 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Introduction Subependymomas are World Health Organization (WHO) grade I tumors, estimated to account for 0.2–0.7% of intracranial neoplasms, most typically presenting in the 5th–6th decades of life [1–3]. These well-circumscribed lesions are typically attached by a narrow pedicle to the cerebral ventricle walls and thought to arise from the subependymal glia [4]. They most commonly occur in the lateral and fourth ventricles, or rarely in the third ventricle, septum pellucidum, or central canal [2, 5]. Histologically, they demonstrate scattered clusters of uniform cells in a fibrillar background with scattered microcysts, low to absent mitotic activity, and no significant increase in vascularity [1, 4]. Magnetic resonance imaging (MRI) typically demonstrates hypointensity to isointensity to white matter on T1-weighted images, hyperintensity on T2-weighted fluid attenuation inversion recovery sequence (FLAIR), and no to minimal enhancement or diffusion restriction. Subependymomas grow by slow expansion without infiltration. The majority are asymptomatic and less than 2 cm in size [1]; however, tumors greater than 4 cm are not uncommon with the tendency to become symptomatic by obstructive hydrocephalus. In such instances, patients present with symptoms related to intracranial hypertension, such as headache, dizziness, nausea, or cerebellar signs, such as gait ataxia. Cognitive decline, seizure, and paresis have also been reported [6, 7]. In this article we report the first case of a small nonobstructive subependymoma under active surveillance, which
Nafi Aygun
[email protected] 1
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
2
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
became acutely symptomatic by detachment of the lesion from the lateral ventricle and translocation into the cerebral aqueduct. While traumatic translocation of colloid cysts from the foramen of Monro into the dependent third ventricle has been reported [8], to the best of our knowledge such a phenomenon has never been reported for nonobstructive small subependymomas or other solid lesions.
Case Presentation A 63-year-old man, reportedly with a benign brain tumor, presented to our emergency room with altered mental status. Per family, he was in his usual state of health until the night of presentation when he became acutely confused, agitated, and had multiple episodes of emesis. Upon arrival to the emergency department, his mental status deteriorated and he became unable to follow commands. The MRI demonstrated hydrocephalus from a 1.2 cm obstructive lesion in the posterior third ventricle (Fig. 1). The lesion demonstrated mild T2 FLAIR hyperintensity, no enhancement,
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