PMC7303770_01
Initial MRI. (a) Large homogeneous hyperintense asymmetric cystic
lesion in the lateral ventricles, delineated by a thin wall
(arrows). Severe dorsal left thalamic compression (arrowhead),
generalised cortical thinning, effacement of the cerebral sulci
and subarachnoid space are observed. (b) The cystic lesion
appears to be closely related to the left choroid plexus
(arrowhead). T2-WI = T2-weighted image; T1-WI = T1-weighted
image
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Measured dimensions were 27.7 x 29.1 x 24.3 mm (length x width x height) (Figure 1).
Two days post-trepanation control MRI. The cyst appears decreased
compared with Figure 1a. Subarachnoid cerebrospinal fluid is
visible and brain herniations were no longer observed (data not
shown). T2-WI = T2-weighted image
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On the 2 days post-decompression MRI, marked decreased size of the lesion, apparent subarachnoid CSF and absence of brain herniation were observed (Figure 2).
Ten days post-cardiorespiratory arrest. (a) Marked enlargement of
the cyst, compared with Figure 2, showing
recurrence of the lesion. Diffuse cortical and thalamic
T2-weighted hyperintensity of the grey matter, compatible with
global brain ischaemia. (b) Diffuse post-contrast signal
enhancement of the cortical and thalamic grey matter. T2-WI =
T2-weighted image; T1-WI = T1-weighted image
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MRI was repeated 10 days post-CPR, demonstrating recurrence of the cystic lesion, diffuse cortical and thalamic T2W and T2-FLAIR hyperintensity of the grey matter and heterogeneous contrast enhancement (Figure 3).
(a) Pre-cystoperitoneal shunting MRI. Increased size of the cystic
lesion, 1 month after the last CT-guided aspiration. The
subarachnoid cerebrospinal fluid is visible contrary to the
initial diagnosis, although the cyst size is similar. This may
be due to cortical atrophy secondary to the global brain
ischaemia. (b) Post-cystoperitoneal shunting MRI. The shunt tip
is visible inside the cystic lesion (arrowhead) and a
significant reduction of the cyst is observed with widening of
the subarachnoid space
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Repeat MRI, 4 days after surgery, revealed a marked reduction of the cyst and adequate placement of the cystoperitoneal shunting device (Figure 4).