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Images in Neurology |

Central Nervous System Epidermoid Cyst Rupture

Ioannis Loumiotis, MD; Jonathan M. Morris, MD
Arch Neurol. 2012;69(1):136-137. doi:10.1001/archneurol.2011.550.
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A 46-year-old man presented with a history of dizziness, headache, and incoordination. His symptoms started suddenly 1 month before presentation and gradually progressed. Magnetic resonance imaging (Figure, A and B) demonstrated a prepontine mass with numerous T1 hyperintense droplets indicating a ruptured posterior fossa epidermoid with dissemination of its contents around the cerebellar hemispheres and along the leptomeninges of the parietooccipital sulcus (Figure, A, arrows). Fat-fluid level in the lateral ventricle was also seen (Figure, A, asterisk). Remarkable hydrocephalous was noted and the patient underwent ventriculoperitoneal shunting. Because of persistent symptoms after shunting, a computed tomographic scan (Figure, C) was done 1.5 months after initial presentation that revealed fat density in the prepontine and ambient regions of T1 hyperintensity, confirming the lipid content (Figure, C, arrow) and improvement of the ventriculomegaly. His symptoms progressively improved without additional treatment and were “tolerable” 17 months after original presentation.

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Figure. Magnetic resonance imaging and computed tomography. A and B, Sagittal and axial T1-weighted magnetic resonance images without gadolinium demonstrate a prepontine T1 hyperintense mass with multiple T1 hyperintense droplets extending through the right ambient cistern into the sulci of the cerebellar hemispheres and along the leptomeninges of the parietooccipital sulcus (arrows). Fat-fluid level in the lateral ventricle is also seen (asterisk). C, The patient underwent ventriculoperitoneal shunting. Because of persistent symptoms, a noncontrast computed tomographic scan of the head was obtained that demonstrates fat density in the prepontine and ambient regions of T1 hyperintensity (arrow).

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