choroid cyst in adults

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This case of a rare symptomatic choroid plexus cyst in the lateral ventricle, which presented with papilledema and decreased vision, is the first such lesion found in an adult. Five earlier reported cases, all in children, are discussed, as are the limitations of computerized tomographic (CT) scanning and the need for further radiological studies to establish the diagnosis preoperatively. Metrizamide ventriculography with CT scanning is used to define the lesion and plan an operative approach.



Choroid plexus xanthogranulomata
 are common, incidental and almost invariably asymptomatic lesions. It is unclear in much of the literature whether they represent a distinct entity from 
adult choroid plexus cysts
, but they share imaging characteristics and are only likely to be distinguishable on autopsy. As the clinical history is the same, the distinction, at least from a radiologist's and clinician's point of view, is largely irrelevant.


Adult choroid cysts and xanthogranulomas should not be confused with antenatal choroid cysts, which usually regress by birth. These lesions are found in adults, and are relatively common (~7%) 2,5, identified most commonly in older patients 5.


These lesions represent desquamated epithelium into the lumen of choroid cysts within the choroid plexus. As a result, the cholesterol/lipid-rich content of epithelial cells accumulates, sometimes combined with blood products, and results in a xanthomatous response, as this material is ingested by mononuclear cells 1,2,5.


The size of xanthogranulomata of the choroid plexus varies widely, ranging from tiny spec-like regions, not visible on imaging, to large prominent choroidal masses. In most cases, they measure below 1 cm in diameter and are usually located in the trigones of the lateral ventricles 5. They are bilateral in two-thirds of cases 5.


On CT these lesions are usually inapparent as they are of a similar density of the adjacent choroid plexus. When larger they can be inferred by the displacement of choroidal calcifications around their periphery.





Signal characteristics on MRI are variable depending on the mixture of lipid, fluid and blood products. In general, they mimic cystic lesions, although they do not fully attenuate on FLAIR. A helpful feature is that they usually have a quite high signal on diffusion-weighted imaging (DWI). This high signal is seen as a result of both true restricted diffusion and T2 shine through (as expected the ADC signal is intermediate rather than particularly low) 5.


Articles: Choroid plexus infarction 
 Intraventricular simple cysts 
 Choroid plexus neoplasms 
 Choroid plexitis 
 Ependymal cyst 
 Intracranial non-neoplastic cysts 
 Choroid plexus xanthogranuloma 
 Choroid plexus cyst (antenatal) 
 Intraventricular masses (an approach) 

Cases: Choroid plexus xanthogranulomas 
 Arachnoid granulation 
 Autosomal recessive spastic ataxia of Charlevoix-Saguenay 
 Choroid plexus xanthogranulomas 
 Aicardi syndrome 
 Choroid plexus cyst 
 Choroid plexus xanthogranuloma 
 Choroid plexus xanthogranuloma 
 Choroid plexus xanthogranuloma 
 Choroid plexus xanthogranuloma 
 Large choroid plexus xanthogranuloma 
 Bilateral choroid plexus xanthogranulomata 
 Choroid plexus xanthogranuloma 
 Intraventricular simple cyst 
 Choroid plexus xanthogranulomas 
 Choroid plexus xanthogranuloma and bilateral chronic subdural hygromata 
 Intraventricular cyst (giant) 
 Choroid plexus xanthogranulomas 
 Basilar artery fenestration and aneurysms with subarachnoid haemorrhage 
 Choroid plexus xanthogranuloma 

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Choroid plexus cysts (CPCs) are the most commom neuroepithelial cysts. They are typicall

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