Colloid cyst: an unusual cause of seizure

A 46-year-old female presented to the emergency department after two episodes of new-onset generalized tonic clonic seizures. She was lethargic and mildly confused with a blood pressure of 143/ 84 mm Hg, pulse of 69/min, oral temp of 36.68C (97.98F), respiratory rate of 14/min, and saturation of 93% on room air. She complained of mild headaches but had no nausea and vomiting. There were no focal neurological deficits on exam. Computed tomography (CT) scan of head showed a 5 5 mm well-circumscribed focal hyperdensity in the region of the foramen of Monro on the roof of the third ventricle, most consistent with a colloid cyst without any mass effect (Fig. 1). Metabolic and infectious etiologies were ruled out and the EEG was negative. Further imaging with contrast-enhanced magnetic resonance imaging (MRI) of the brain confirmed the CT findings. She was given intravenous (IV) lorazepam 1 mg and started on 500 mg of oral levetiracetam daily. The confusion improved gradually over the next day. Neurosurgery and neurology were consulted. Levetiracetam was continued and elective surgical removal was offered to the patient. On subsequent follow up with neurosurgery and neurology, she complains of on and off headache and is being maintained on levetiracetam. However, she has not decided on surgery till the time of writing.