Cisternography Image
Superior
Cerebellar Cistern Arachnoid Cyst with CSF Communication
Laura
Norman, CNMT
Senior Student NMT
Medical
R.
K. Halkar, M.D.
- Mary Anne Owen, MHE (RT)N
- Program Director, Nuclear Medicine Technology
- Medical College of Georgia
Patient is a 17-year-old female with a chief
complaint of headache, blurred vision and problems with balance and
diplopia. She also has a history of a motor vehicle accident five weeks
ago. Shortly thereafter, she
developed problems with double vision and visual loss.
It was then documented that she had papilledema and an ophthalmic
paresis. An MRI scan showed a
cyst in the region of the tectal plate in the dorsal brain stem.
The patient more recently presents with right facial numbness,
right hand tingling, and a headache rated as a
Prior Studies
MRI scan shows a cyst of the quadrigeminal plate. The cyst does not appear to communicate with the ventricular system. While the cyst itself is just under 3.0 cm in size, the ventricles themselves are not enlarged.
A second MRI was done a week later and it was found that there was CSF signal collection in the superior cerebellar cistern, which extends cranially and to the right into the posterior aspect of the right lateral ventricle. The impression included a superior cerebellar cistern arachnoid cyst with extension into the posterior aspect of the right lateral ventricle, prominent CSF space surrounding the optic nerves bilaterally, and evidence is seen of minimal left maxillary sinus disease.
Following the findings of the above-mentioned studies, the patient underwent a nuclear medicine cisternogram to further evaluate CSF flow and communication.
Findings
Tracer appearance in the basal cisterns is prompt with subsequent uniform progression of tracer over the cerebral convexities. At 24 hours, tracer concentration is noted in the region of the sagittal sinus and over the convexities. There is a focal area of increased tracer concentration in the region of the tectal plate in the dorsal brain stem. 48-hour delay images demonstrate persistent tracer accumulation in the same area that corresponds to CT findings of a low-density area. No tracer retained in the ventricular system and minimal tracer is noted in cerebral convexities. These findings were compared to the most recent MRI. These findings are consistent with a cyst corresponding to the MRI findings, which has communication with CSF, and no communication to the ventricular system.