A 3-year-old boy with increased head circumference

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Presentation transcript:

A 3-year-old boy with increased head circumference Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology

Clinical Vignette A giant cystic lesion(6x8x11cm) of left middle cranial fossa was found incidentally in a 3-year-old boy with head MRI examination for increased head circumference. Surgical intervention was refused by his parents since the boy was asymptomatic, and the patient was followed up. Repeated MRI performed two years later revealed the complete disappearance of the cystic lesion, and the compressed brain tissue had significantly re-expanded There was no history of head trauma and stroke for him. © 2014 American Academy of Neurology Liu et al.

Imaging Liu et al. Figure 1: Brain MRI Axial-T2WI (A, B), axial-T1WI (D, E) and coronal-FLAIR image (C, F) showing a giant cystic lesion in the left middle cranial fossa, and brain tissue was significantly compressed. Arachnoid cyst was diagnosed, which is defined as simple cyst with CSF density on imaging displacing adjacent structures, with or without bony remodeling. © 2014 American Academy of Neurology Liu et al.

Imaging Liu et al. Figure 2: Repeated MRI Axial-T2WI (A, B), axial-T1WI (D, E) and coronal-FLAIR image (C, F) indicating the complete disappearance of the cyst and the compressed brain tissue has expanded into the seemingly normal left temporal lobe (Black arrow). Axial-T1WI (E) revealing that there was residual cyst wall (White arrow). © 2014 American Academy of Neurology Liu et al.

Spontaneous resolution of a giant intracranial arachnoid cyst Arachnoid cyst is simple cyst with CSF density on imaging displacing adjacent structures, with or without bony remodeling. The spontaneous resolution of a giant intracranial arachnoid cyst is extremely rare and the mechanism is not clear. 1 Al-Holou WN, Yew AY, Boomsaad ZE, Garton HJ, Muraszko KM, Maher CO. Prevalence and natural history of arachnoid cysts in children. J Neurosurg Pediatr 2010; 5:578–585. 2 Inoue T, Matsushima T, Tashima S, Fukui M, Hasuo K. Spontaneous disappearance of a middle fossa arachnoid cyst associated with subdural hematoma. Surg Neurol 1987; 28:447–50. © 2014 American Academy of Neurology Liu et al.