Hemorrhagic colloid cyst of the third ventricle: fulminant deterioration

Introduction. Colloid cysts are benign tumors of the third ventricle. Most of them remain asymptomatic. However, some patients can develop since intermittent headaches to an acute deterioration and even sudden death. Several theories exist for which there would be a sudden death in these patients, among which include the rapid increase in size of the cyst, its rupture, the disturbance of hypothalamus-mediated cardiovascular reflex control and the unusual bleeding of the cyst, with only 15 cases described in the literature. Case report. A 45 year old male with hypertension with acute hydrocephalus due to a hemorrhagic colloid cyst in the third ventricle. An external ventricular drain on each side was introduced and he was admitted to the ICU, where brain death was certified. After removal of the cyst through transcortical frontal approach, the diagnosis of colloid cyst with remains of hemolyzed blood was confirmed. Conclusion. Bleeding in colloid cysts is exceptional, and can occur in both symptomatic and asymptomatic patients, making it difficult to recognize this complication.