Tectal plate cysts are rare, benign brain lesions that expand the tectal plate and compress the quadrigeminal cistern. A patient presented with headaches, vision issues, nystagmus, and eyelid retraction. MRI revealed a well-defined cystic lesion in the quadrigeminal cistern, thinning and stretching of the tectal plate, and compression of the cerebral aqueduct and fourth ventricle. The patient underwent ventricular shunting surgery, which provided symptomatic relief and neurological improvement. MRI is the gold standard for differentiating tectal plate cysts from arachnoid cysts of the quadrigeminal cistern.

1. TECTAL PLATE CYST : AN UNUSUAL PRESENTATION
Author –Dr. Pratibha Bafna
Co-author –Dr. Satish Pathak (Professor &HOD)
Affiliation – Teerthankar Mahaveer Medical College , Moradabad ,U.P

2. BACKGROUND
• Tectal plate cyst are rare , benign tumour like lesions .
• It is expansion of tectal plate with a rim of brain and squashes the quadrigeminal CSF
cistern . Its differential diagnosis lies in arachnoid cyst of quadrigeminal cistern . The
former is intraparenchymal and the later compresses the cerebral aqueduct by
directly pushing the tectum forward .
• It requires close radiological and clinical surveillance because of its varied symptoms
asscociated with tectal plate compression or secondary to obstructive hydrocephalous
like headache , vomiting , ataxia ,cognitive impairment .

3. HISTORY AND IMAGING TECHNIQUES
• CHIEF COMPLAINT–
The patient presented to the hospital with complains of
headache(intermittent and throbbing ), short sighted vision. Clinically
there was anisocria (left pupil greater than right ), nystagmus, bilateral
upper eyelid retraction with normal ocular movements .
• IMAGING –
MRI imaging was done with sequencing of T1 W, T2 W , T2 FLAIR , DWI
,post contrast T1 ,GRE 3D sequencing was done and images obtained
in coronal , saggital and axial sections

4. RESULTS –
T2 W IMAGE T1 POST CONTRAST
IMAGE
SWI IMAGE

5. INTERPRETATION –
• A well defined cystic lesion which follows CSF on all sequences , located in the region of
quadrigeminal cistern associated with thinning , flattening and stretching and long
curvilinear appearance of tectal plate with almost complete obliteration of aqueduct of
sylvius is seen .
• Supratentorial and infratentorial extension is seen along with compression and
deformity of IV ventricle, superior and inferior cerebellar peduncle.
• Superiorly mass is causing extrinsic compression & deformity of third ventricle in the
region of suprapineal recess.
• However lateral and third ventricle are normal in size due to ventriculo- peritoneal
shunt seen in situ .
• The lesion shows no obvious diffusion restriction /post contrast enhancement.

6. CONCLUSION-
• Though majority of simple tectal plate cyst and arachnoid cyst of quadrigeminal
cistern have similar clinical features , they can be differentiated on MRI; making
MRI as the gold standard for diagnosis .
• The patient underwent surgery ( ventricular shunting ) and symptomatic relief
with improvement in neurological symptoms was noted ensuring surgery is the
mainstay of treatment .
• With increased awareness about the entity , many more cases can be discussed in
future .