Multilobulated Cystic Formation in the Brain Stem with Benedikt's Syndrome

Abstract

A 26-year-old man presented with an unusual multilobulated cystic formation in the brain stem with normal pressure hydrocephalus, followed by fluctuating cyst volume and Benedikt's syndrome. Ventriculoperitoneal shunting to relieve the hydrocephalus caused an increased cystic size, resulting in worsened neurological deficits. Cystectomy and an additional shunt resolved the symptoms. Immunohistochemical and electron microscopic examinations of the surgical specimen revealed no epithelial lining but numerous astrocytic processes on the luminal surface, probably resulting from expansion of the cyst. This case suggests that cystectomy before shunt emplacement is recommended in similar cases.

Dilatations géantes des espaces de Virchow-Robin symptomatiques

“…Si une association statistique semble exister chez des patients pré sentant é pilepsie (Bastos et al, 1998), syndrome dé mentiel (Vital and Julien, 1997) ou bien migraine (Machado et al, 2001), leur lien exact avec la pré sence de DEVR n'est pas clairement é tabli. En effet, si le lien entre DEVR profondes exerç ant un effet de masse et modification de la circulation du LCR responsable d'hydrocé phalies non communicantes est avé ré (Homeyer et al, 1996) (House et al, 2004) (Kanamalla et al, 2000) (Longatti et al, 2003) (Marnet et al, 2007) (Mascalchi et al, 1999) (Ono et al, 1994) (Papayannis et al, 2003) (Poirier et al, 1983) (Salzman et al, 2005) (Schroeder et al, 1996), dans le cas de DEVR de localisation hé misphé rique, leur dé couverte reste le plus souvent fortuite (Shiratori et al, 2002) ou associé es à des symptô mes aspé cifiques (Ogawa et al, 1995) (Mathias et al, 2007). Certains cas rapporté s laissent né anmoins suggé rer comme dans nos 2 derniers cas de phé nomè nes é pileptiques ou bien dé ficits focaux, progressifs directement en lien avec les DEVR (Bastos et al, 1998) (Buerge et al, 2011).…”

Traumatic Intracystic Hemorrhage in a Case with Thalamo-Mesencephalic ‘Expanding Lacunae’: An Uncommon Cause of Sudden-Onset Neurological Signs

“…They are usually characterized by an insidious progressive onset of extrapyramidal, hydrocephalic and midbrain syndromes [1,4,5,7]. They can also be asymptomatic [2], presenting as an incidental autopsy finding.…”

“…Dorsal medullary infarction with marked disturbance of the dorsal column function is a rare clinical condition [4]. With this stroke vignette we wish to emphasize that in a clinical setting a predominantly sensory syndrome can be easily misattributed to a lesion of the contralateral parietal lobe, white matter or thalamus [5]; in particular if other brainstem signs are missing.…”

Neuroendoscopic options in the treatment of mesencephalic expanding cysts: Report of four cases and review of the literature

“…Lastly, they must be differentiated from mesencephalic ependymal cysts, as described by Conrad [17].While frequent elsewhere in the brain, expanding dilations of Virchow-Robin spaces are very rarely located in the midbrain [1]. They cause two main categories of symptoms: those caused by midbrain compression (e.g., Benedikt's syndrome [18,19] or Parkinson-like syndrome) and those by secondary obstructive hydrocephalus, with intracranial hypertension or signs of normal pressure hydrocephalus. The expanding nature of mesencephalic cysts, causing progressive clinical worsening, justifies surgical management, with minimally invasive treatment being an attractive option.…”