Chronic headaches, dizziness for 4 years, History of left occipital craniotomy and VP shunt.
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Left extra-axial CPA cystic lesion exhibiting true diffusion restriction with no post-contrast enhancement.
Subtle changes of prior right sided VP shunt and left occipital craniotomy.
The patient initially presented with recurrent persistent headaches, dizziness and nausea 4 years back, for which MRI was done and revealed the characteristic appearance and location of intracranial epidermoid cyst at left cerebellopontine angle (CPA). Surgical debulking was attempted at that time and histopathological verification was done.
The main feature to differentiate an epidermoid cyst from an arachnoid cyst is true diffusion restriction (bright signals on DWI, intermediate to low on ADC).