Solitary cysticercal cyst insidethe Blake's pouch remnant of mega cisterna magna with associated aqueductal stenosis: The clinical and management implications.

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Solitary cysticercal cyst insidethe Blake's pouch remnant of mega cisterna magna with associated aqueductal stenosis: The clinical and management implications.

World Neurosurg. 2017 Apr 18;:

Authors: Das KK, Gosal JS, Singh S, Mehrotra A, Jaiswal A, Jaiswal S, Kumar R

Abstract
BACKGROUND: Intraventricular and subarachnoid forms represent the relatively complex albeit uncommon manifestations of the central nervous system involvement by the cysticercal cysts. Cysticercal encystationinsidethe Blake's pouch remnant of mega cisterna magna remainsan extremely rare clinical scenario and to the best of our knowledge, has not been reported before.
CASE REPORT: Herein, we report the case of a 12-year-old boy who presented with acute worsening and subsequent spontaneous resolution of his compensated hydrocephalus. Neuroimaging revealed features consistent with a mega cisterna magna with septum inside, indicating remnants of the embryologic 4(th) ventricular diverticulum, the Blake's pouch. It also revealed a free floating intact cysticercal cyst inside the mega cisterna magna limited by the septumwith aqueductal stenosis. The spontaneous clinico-radiological resolution of hydrocephalus raised the possibility of ball valve obstruction of the cerebrospinal fluid outflow i.e.the Brun's syndrome. We successfully treated this patient with endoscopic extraction of the viable cysticercal cyst utilizing a sub-occipital burr hole.
CONCLUSION: The clinical scenario we present has not been described before. Endoscopic cyst removal in these situations is an effective, low risk procedure and obviates any further need for antihelminthic medications.

PMID: 28434960 [PubMed - as supplied by publisher]

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