Central Neurocytoma Mimicking a Hemorrhagic Ependymal Cyst

Central neurocytoma (CN) is a rare intraventricular tumor, predominantly affecting young adults without sex predilection. Differential diagnosis includes other intraventricular tumors, emphasizing the need for accurate preoperative diagnosis. Surgical resection remains the cornerstone of treatment, with favorable long-term survival outcomes. We present a case of CN in a 65-year-old male presenting with diplopia and headache. Magnetic resonance imaging (MRI) revealed a multicystic right ventricular lesion without solid components, asymmetric ventriculomegaly, and evidence of prior hemorrhage. Histopathological examination confirmed CN. This case of an atypical appearing central neurocytoma, lacking solid components or enhancement and with evidence of prior hemorrhage highlights the importance of keeping central neurocytoma on the differential for an intraventricular mass, even when the typical findings are absent. Initial differential considerations were led with more benign entities, like hemorrhagic complications of a choroid or ependymal cyst.