Colloid cyst of the third ventricle is a rare benign lesion accounting for 0.5% of all brain tumors, a small subset of these patients can present with acute neurological deterioration which can be fatal. Estimate the risk of acute deterioration in patients and to assess the outcomes in patients with symptomatic colloid cysts. Retrospective correlative study of all patients diagnosed to have colloid cyst based on neuroimaging studies[CT and or MRI] at JSS Medical College and Hospital during the period January 1, 2014 to January 31, 2016. Of the 24 patients included in the study, 8 patients presented with acute neurological deterioration of whom, four died suddenly following diagnosis. Estimated risk of deterioration was 36%, but mortality in the subset of patients with acute neurological deterioration was as high as 50%. Risk factors for acute deterioration based on patient age, cyst size and density on plain CT, and presence of hydrocephalus were evaluated. Positive correlation was obtained for cyst size and hydrocephalous. While most patients have an insidious clinical course, a small unpredictable cohort of patients present with a cascade of neurological which can culminate in sudden death, necessitating early surgical intervention. Early intervention with ventriculostomy as an interval procedure in the setting of Emergency Department can often prove to be life saving.