Colloid Cyst Causing Massive Headache Attacks

A 12-year-old boy presented with acute onset of unilateral headache preceded by 3 days of holocephal headache. His medical history was not remarkable, and clinical examination was without any significant findings. Headache episodes recurred with increasing intensity twice per day in a stringent circadian rhythm. While in pain the patient showed nonresponsiveness, tachypnea, and partial hallucinations. Analgesic treatment (including opiates and indomethacin) and high-flow oxygen inhalation remained without effect. Brain magnetic resonance imaging revealed a 9-mm lesion in the roof of the third ventricle. After total surgical excision of the lesion (histopathological: colloid cyst) via a left frontal access, our patient experienced immediate symptom relief. Colloid cysts are columnar epithelium-lined cysts, which originate from abnormal folding of the neuroepithelium.[1] Although benign, location in proximity to the foramen of Monro can lead to liquor flow obstruction, causing obstructive hydrocephalus and symptoms such as thunderclap headache, vomiting, unconsciousness, or even sudden death.[2] [3] On the last follow-up, our patient was symptom free ([Fig. 1]).