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Expanding cerebral cysts (lacunae): a treatable cause of progressive midbrain syndrome
  1. P L Longatti1,
  2. A Fiorindi1,
  3. A Carteri1,
  4. F Caroli2,
  5. A Martinuzzi3
  1. 1Neurosurgical Unit, Treviso Hospital, Treviso, Italy
  2. 2Istituto Regina Elena, Rome, Italy
  3. 3E Medea Scientific Institute, Conegliano Research Centre, via Costa Alta 37, 31015 Conegliano (TV), Italy
  1. Correspondence to: Dr Andrea Martinuzzi;

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A progressive motor defect presenting in adulthood is an ominous sign, being often associated with either neoplasia or neurodegenerative diseases. Notable if very rare exceptions to this poor prognosis are cerebral expanding lacunae or, as they are sometimes called, benign intraparenchymal brain cysts.1 These are intraparenchymal cavities without an epithelial lining, filled with cerebrospinal fluid (CSF), located in the thalamo-mesencephalic arterial territory.1,2 Their expanding nature is demonstrated by their progressive clinical course and by the frequent complication of aqueduct stenosis and triventricular hydrocephalus.2–4

We present a case of progressive midbrain syndrome associated with expanding cysts, which was successfully treated by neuroendoscopy.

Case report

A 43 year old woman with an unremarkable clinical history presented in 1996 with progressive resting tremor and weakness of the left arm. The tremor persisted during posture maintenance and action. Within a year the motor problems extended to the left leg. Brain magnetic resonance imaging (MRI) showed large (10 to 20 mm) well defined lesions with signal intensities identical to CSF occupying most of the right thalamo-mesencephalic region. There was no contrast enhancement either in the lesions or in the surrounding tissue. The ventricular spaces were only mildly enlarged. …

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  • Competing interest: none declared