Hemorrhagic Fourth Ventricle Colloid Cyst: A Report of an Unusual Presentation at an Uncommon Location

Abstract

Colloid cysts are benign cystic lesions characteristically arising from the third ventricle roof close to the foramen of Monro. Although incredibly rare, hemorrhage within a third ventricular colloid cyst is sparsely reported. To the best of our knowledge, no cases of hemorrhage within the fourth ventricle colloid have ever been documented. Here, we present an interesting case describing a hemorrhagic colloid cyst situated within the fourth ventricle of a 55-year-old female patient who presented with symptoms of headache, vomiting, and gait imbalance. The cyst was excised during surgery via a suboccipital microscopic telovelar approach. Our findings led us to the conclusion that, despite being extremely rare, colloid cysts in the fourth ventricle can present with hemorrhagic episodes, which can exacerbate symptoms and hasten neurological decline. As a result, the presence of unusual radiological characteristics in a fourth ventricle lesion should prompt medical practitioners to suspect an atypical colloid cyst. This consideration can be pivotal in making informed surgical decisions. Expedited management and a microsurgical approach are recommended strategies for a better outcome.