Epidermoid cyst (4th ventricle)
Female, 67y, presenting with a mild headache. No other symptoms.
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Mass epicentered upon the fourth ventricle, with a low T1 signal, high T2 signal and dirty slightly hyperintense FLAIR signal (partial suppression). Intense bright signal on DWI sequences and no enhancement after contrast injection. The mass expands the foramen of Magendie and right foramen of Luschka.
The typical features of an epidermoid cyst are illustrated in this case: the mass follows the CSF signal both on T1 and on T2 sequences. Dirty FLAIR signal is often seen, and the combination of restricted diffusion and T2 shine-through effect causes a bright DWI signal. The location on the fourth ventricle is not unusual.