Sudden death after air travel in a patient with colloid cyst

Clinical and radiological characteristics in fatal third ventricle colloid cyst. Literature review

BACKGROUND

Colloid cysts are a benign tumor that is almost exclusively found in the third ventricle and may cause hydrocephalus and rarely life-threatening acute deterioration and even sudden death. With very few cases of sudden death reported in literature not much is known about the patient and cyst characteristics in these patients. The authors present a review of 65 cases of colloid cyst attributed deaths in literature.

MATERIALS AND METHODS

A literature search for sudden death with radiologically or pathologically identified colloid cyst was done on PubMed, google scholar, Medbase and clinicaltrials.org research drives. Patient demographics, symptoms and cyst characteristics were recorded and analyzed. A Bivaret Pearson correlationcoefficientwas used to analyze and compare the relationship between each antecedent symptom, cyst size, and, cyst hemorrhage in patients who subsequently succumbed and died in order to ascertain possible relation.

RESULTS

Most patients had a history of sudden severe headaches (p = 0.01) with associated vomiting (p = 0.03). Radiologically, cyst associated ventriculomegaly was seen in 97% (P = 0.78) was a notable feature. Even more, the cyst size (p = 0.01) and associated hemorrhage (p = 0.02) were also major notable feature preceding sudden death in both gender group.

CONCLUSION

Acute deterioration in colloid cysts is rare, but can be fatal. Associated symptoms include severe headache and vomiting. Seizures are commonly seen in patients in the first two decades. Given the risk of acute deterioration and mortality, headaches should be thoroughly investigated and all patients diagnosed with a colloid cyst > 1 cm should be offered surgical management regardless of symptom profile.

Flying with Colloid Cyst: A Cautionary Note

BACKGROUND

Colloid cysts are benign and rare tumors of the brain. The growth rates of these tumors are unpredictable. These cysts can increase in size and obstruct the cerebrospinal fluid pathways producing obstructive hydrocephalus. Consequently, this can manifest as acute severe headaches followed by deterioration in consciousness, or even sudden death in patients. Such remarkable episodes occurring in patients during air travel have been reported sparsely in the literature.

CASE DESCRIPTION

In this report, we narrate the ordeal of a patient who had severe headache followed by loss of consciousness during his air travel. After his arrival, he was taken to a referral center where the diagnosis of a colloid cyst obstructing the cerebrospinal fluid pathway resulting in acute obstructive hydrocephalus was revealed. We analyze the physiologic effects of cabin pressure and high altitude on the intracranial pressure and present a brief review of the literature.

CONCLUSIONS

Changes in cabin pressure during flight may play a role in worsening of intracranial pressure in patients with colloid cyst with marginal brain compliance.

Fatal Colloid Cysts: A Systematic Review

OBJECTIVE

To accurately describe patient characteristics and the clinical presentation of fatal colloid cysts.

METHODS

A systematic literature search of 3 popular databases was performed. Inclusion criteria were individuals with sudden-onset death and colloid cysts identified on imaging and/or autopsy. The cause of death must have been ascribed to the colloid cyst to be eligible for data extraction. Deaths precipitated by lumbar puncture were excluded. Clinical data were extracted and descriptive statistics were ascertained. Subgroup analyses were performed to compare adults with pediatric patients.

RESULTS

A total of 107 patients were included in the quantitative synthesis. The mean age was 28.5 years (standard deviation 13.3, range 6-79 years). Male and female patients were affected equally. Headache was the most frequent symptom (n = 86, 80%). There were 6 patients (5 adults and 1 child) who reported positional headaches. The mean duration of signs and symptoms was shorter in adults versus pediatric patients (2.1 days vs. 6.5 days, P = 0.02), and more adults presented with signs and symptoms for less than 24 hours than did pediatric patients (38% vs. 6%, P = 0.01). Colloid cyst mean diameter was 2.0 cm (standard deviation 1.1, range 0.5-7.9 cm) and 96% measured 1 cm or larger.

CONCLUSIONS

Our data suggests that the prodrome preceding sudden death in the setting of a colloid cyst may be shorter in adults. Also, most fatal colloid cysts measured 1 cm or larger.

Sudden intraaqueductal dislocation of a third ventricle ependymoma causing acute decompensation of hydrocephalus

The authors report an unusual sudden intraaqueductal dislocation of a third ventricle ependymoma causing acute loss of consciousness, and they detail its neuroendoscopic treatment. This case is unique and has never been described in the literature before. The patient suffered from headache and recurrent nausea. Admission MR images revealed a contrast-enhancing lesion within the posterior part of the third ventricle. During the course of the day of admission, the patient suddenly became comatose. Emergency MR imaging demonstrated a deeply intraaqueductal dislocation of the pedicled tumor, with complete obstruction of the aqueduct and ventricular dilation. Immediate surgical intervention with endoscopic third ventriculostomy and complete tumor removal was performed. After surgery, the patient made a rapid recovery. In this case, the authors presume a sudden intraaqueductal dislocation of the ependymoma caused by aspiration of the tumor as a result of the caudal CSF flow.

Barometric changes in patients with intracranial lesions: can they dive and fly?

BACKGROUND

People who harbor a neurosurgical lesion or who have just been operated on raise doubts to their physician about the possible risks related to transcontinental flights or practicing some sports (eg, diving, climbing) characterized by sudden barometric changes.

CASE DESCRIPTION

A young male patient harboring a high-grade cerebral glioma presented the first symptoms after a diving expedition and subsequent transatlantic flight.

CONCLUSIONS

This case hinted the authors to review the literature on this controversial topic where there is lack of scientific evidence, trying to define the possible risks and making a general recommendation.