A colloid cyst (neuroepithelial cyst) is a slow-growing, benign tumor that occurs in the anterior third ventricle.1 Colloid cysts of the third ventricle represent 0.5%-2% of all intracranial tumors. 2,3 The common presenting symptoms are headache, nausea, vomiting, sudden drop-attacks, memory loss, mental status changes, gait disorder, insomnia, and visual disturbances.4 Colloid cysts frequently cause psychiatric manifestations including mania5 , psychosis,6 depression,7 anxiety , Korsakoff type presentations,8 and dementia.9 We here , report a case who presented with organic manic disorder , which showed symptomatic improvement after the surgery.

1. INTRODUCTION
A colloid cyst (neuroepithelial cyst) is a slow-growing,
benign tumor that occurs in the anterior third
ventricle.1 Colloid cysts of the third ventricle represent
0.5%-2% of all intracranial tumors. 2,3
The common presenting symptoms are headache,
nausea, vomiting, sudden drop-attacks, memory loss,
mental status changes, gait disorder, insomnia, and
visual disturbances.4 Colloid cysts frequently cause
psychiatric manifestations including mania5 ,
psychosis,6 depression,7 anxiety , Korsakoff type
presentations,8 and dementia.9
We here , report a case who presented with organic
manic disorder , which showed symptomatic
improvement after the surgery.
DISCUSSION
Colloid cysts are rare intracranial lesions with an
incidence of 1% per million person-years in
epidemiological studies. Various symptoms are
characteristic of colloid cysts that may be detected
incidentally for unrelated symptoms or because of
specific problems caused by the cyst itself.
The patients symptoms were characterized by elevated
mood, disturbed sleep, pressure of speech, flight of
ideas and delusions of infidelity and grandiosity. Of the
psychiatric manifestations , though rare, recurrent mania
is commonly seen followed by depression and
schizophrenia like symptoms 5-7. In one case report ,
Bhatia MS et al.(2013) described about 24 year old
female with recurrent mania diagnosed of having
Colloid cyst obstructing foramen of Monro causing
dilated lateral ventricles and the symptoms resolved
completely within six months post operatively5. Of the
neurological manifestations , Headache is the most
common symptom, followed by gait disturbances,
frequent dropouts, transient loss of consciousness4.
Diagnosis of colloid cyst is by neuroimaging of brain
(CT/MRI), where as definitive treatment is surgery.
Neuroendoscopic Surgery (Trans-callosal
approach) is advised as the primary way of
management for colloid cysts 2.
In this case, colloid cyst could be contributing to the
psychiatric manifestations and was decided to be
operated on. Anti-psychotics were kept in a lower dose
and sodium valproate was also used to prevent seizures
post-operatively.
Certain comorbid psychiatric conditions like Alcohol
dependence have the same neurological
manifestations and can mask the symptoms of
colloid cyst , there by delaying the diagnosis and
worsening the prognosis of the patient 10. Hence, a High
index of suspicion for the diagnosis is necessary.
Dr. P. Sravanthi , Dr.Kailash.S , Dr.B.Srinivasan , Dr.Sabari Sridhar OT ,
Dr.S.B.Gopalakrishnan , Dr. Shabeeba Kailash , Dr. Sivabackiya.C.
REFERENCES
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of colloid cyst of third ventricle: long-term results in a
series of 6 consecutive cases. Minim Invasive Neurosurg
2007; 50:313–317
3. Hadley DM: Colloid cyst of the third ventricle. J Neurol
Neurosurg Psychiatry 2002; 72(Suppl 2)
4. Lajara-Nanson WA: Neuropsychiatric manifestations of a
third-ventricular colloid cyst. Am J ForensicMedPathol
1980;1:29–45
5. Bhatia MS, Srivastava S, Jhanjee A, Oberoi A: Colloid cyst
presenting as recurrent mania. J Neuropsychiatry Clin
Neurosci 2013; 25:E01-E02.
6. Upadhyaya AK, Sud PD. Psychiatric presentation of third
ventricular colloid cyst. A case report. Br J Psychiatry
1988;152:567–9.
7. Jones AM. Psychiatric presentation of a third ventricular
colloid cyst in a mentally handicapped woman. Br J
Psychiatry 1993; 163:677–8.
8. Lobosky JM, Vangilder JC, Damasio AR. Behavioural
manifestations of third ventricular colloid cysts. J Neurol
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9. Yenermen MH, Bowerman CI, Haymaker W. Colloid cysts
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Dacey RG Jr (2016) Natural history of colloid
CONCLUSION
Space occupying lesions like colloid can present with
symptoms of mania, which should be evaluated properly
for the effective outcome of the patient.
CASEREPORT
A 30 year old man was brought to the OPD with
symptoms of pervasive irritability and
disinhibited behavior for 3 months. Family
members reported that his behavior changed
suddenly; also reported increased activity and reduced
sleep and appetite, , watching television in high
volume throughout the night, believes that he can do
any job and need not work under someone, suspicious
about wife’s fidelity and acting out on that . However,
patient denied all the complaints saying he is normal .
History of Head injury 8 years back, associated with
loss of consciousness ; took treatment for 6 months
and discontinued. He started consuming alcohol at the
age of 20 years, admitted in the past for 5 times for
de-addiction ; not compliant to medication. For all the
above complaints, he was diagnosed with MANIA
with psychotic symptoms (YMRS – 42) and started
on T. Sodium Valproate 300mg BD , T. Olanzapine 10
mg HS .
In view of frequent episodes of headache in the past
3 months associated with nausea, restlessness,
more during early morning hours , Neuroimaging was
done. On CT brain, findings suggestive of colloid
cyst of third ventricle with obstructive
hydrocephalus were reported which were confirmed
by MRI . Patient was referred to Neurosurgery and
cyst was excised by trans-callosal and trans-
foraminal approach . Biopsy report showed a cyst
filled with acellular eosinophilic material , lined by
pseudo stratified ciliated columnar epithelium to single
layer of cuboidal epithelium with choroid plexus,
consistent with colloid cyst .
COMMUNICATION ADDRESS
Dr. Penubarthi Sravanthi
Department of Psychiatry,
Chettinad Hospital And Research Institute,
Kelambakkam, Chennai, Tamilnadu - 603103
CT brain (sagittal
view ) showing the
colloid cyst (1.2*1.2cm)
MRI Brain with
contrast (Axial
View) showing
colloid cyst involving
roof of 3Rd ventricle
Patient had been followed up twice monthly after
surgery and the symptoms were reduced. Patient
attained his premorbid level within two months of
surgery (YMRS-5).