Introduction: Colloid cysts have been associated with acute neurologic deterioration and sudden death. However, due to their low incidence, the clinical factors predicting acute neurological deterioration and sudden death have not been well described in the literature.
Methods: A literature search was performed on Pubmed to identify all patients who presented with acute neurological deterioration and had a radiographic, histologic or pathologic diagnosis of colloid cyst. Patients with other 3rd ventricular lesions presenting in extremis were excluded. Patients with colloid cysts who did not present acutely were also excluded. Demographic data, presenting physical exam and symptoms, surgical interventions and outcomes were recorded. All statistical tests were performed in R version 3.2.1 for Windows 64-bit.
Results: 140 patients were analyzed. The most frequent presenting symptoms were headache (96%), change in mentation (72%) and nausea/vomiting (64%). On physical exam, 57% of patients had papilledema. 98.6% had a radiographic or autopsy proven diagnosis of hydrocephalus. The mean cyst size was 2.12 cm in males and 1.59 cm in females (P=0.155), and 1.64 cm in patients who survived and 2.05 cm in patients who died (P=0.04).
The minimum cyst size was 0.4 cm in females and 0.8 cm in males. A greater percentage of females died prior to any intervention than males: 32% vs. 13%, respectively (p=0.09).
100% of patients who had no surgical intervention performed died, versus 48% of patients who had surgical intervention (p<0.0001).
Conclusions: Patients with colloid cysts who have headaches (96%) in conjunction with a radiographic finding of hydrocephalus (98.6%) are at extremely high risk for acute neurological deterioration and sudden death. Females, even with smaller cyst sizes, are at higher risk for sudden death, and should be more aggressively managed.
Patient Care: Help clinicians identify patients with colloid cysts who are at high risk for neurological deterioration.
Learning Objectives: By the conclusion of this session, participants should be able to 1) Identify patients with colloid cysts who are at high risk for neurological deterioration 2) Understand the clinical presentation of patients with colloid cyst.