Presentation
Acute onset of severe headache.
Patient Data
The patient had a history of hydrocephalus and underwent a VP shunt insertion.
Complex right temporal intra-axial lesion. On T1 weighted images it displays heterogeneous intensity predominantly low signal in the center of the lesion with peripheral hyperintensity. On T2 weighted axial images the lesion is predominantly hyperintense in the center and periphery. There is prominent chemical shift artefact at the anterior margin of the T1 hyperintense components confirming that this is fatty material. Furthermore, the peripheral component demonstrates signal loss on fat-suppressed T2 gradient echo sequences. Scattered rounded droplets of hyperintense signal in T1 and FLAIR are seen disseminated within the subarachnoid space.
Case Discussion
Diagnosis: dermoid cyst after rupture.
The dermoid cyst has ruptured and its fatty content becomes disseminated within the subarachnoid space resulting in T1/FLAIR hyperintense droplets. After evacuating its content, its center became hypointense on T1 and may resemble any other cystic lesions.
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