A 17-year-old boy presents for evaluation of headache, nausea, and vomiting following a motor vehicle collision. He was a restrained driver who lost control of his vehicle and hit a tree; the air bag did not deploy. There was questionable brief loss of consciousness.
The patient’s medical history is unremarkable, and the physical exam overall is normal. CT without contrast of the head is obtained. The preliminary reading suggests a small hemorrhage within the cerebrum. An image of the area in question is shown. What is your impression?
Answer
There is a well-rounded, hyperdense lesion right in the midline, sitting in the superior aspect of the third ventricle. While hemorrhage is a possibility, especially with a history of recent injury, this finding is more consistent with an intracranial mass/cyst—in this case, a colloid cyst, which is typically found in this location.
The patient was admitted overnight for observation. Repeat CT of the head the next morning showed no change, and follow-up MRI of the brain confirmed the colloid cyst. His postconcussive symptoms improved, and he was discharged later that day with a plan for subsequent outpatient follow-up.
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