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CP angle epidermoid

Case contributed by: Dr Gagandeep Choudhary

Presentation:

Young female presented with tinnitus and headache

Modality: MRI

Case Discussion:

An epidermoid cyst is an inclusion cyst. They are benign congenital lesions of ectodermal origin. They account for approximately 1% of all intracranial tumors. Although these lesions are congenital, patients are usually not symptomatic until they are aged 20-40 years. The most common locations are around the brainstem, pituitary gland and in the posterior fossa along the cerebellum and brainstem. Some epidermoid cysts can rupture and result in a meningitis type reaction from inflammation. It insunates along the cisterns. No malignant degeneration seen.

Cauliflower like surface with mother of peal appearance on gross examination.

Imaging:

CT

  • Attenuation similar to CSF, calcification seen on 10-25% of cases. No contrast enhancement seen.

MRI

  • Typically have intensity similar to CSF on T1 and T2
  • Not supreses on FLAIR and shows no contrast enhancement. 
  • On ADC intensity similar to brain parenchyma. and shows restricted diffusion on DWI.

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