Epidermoid cyst - obstructive hydrocephalus

Case contributed by Ammar Haouimi
Diagnosis almost certain


Symptoms of raised intracranial pressure

Patient Data

Age: 30 years
Gender: Male

There is a well-circumscribed, lobulated midline cystic lesion of the posterior cerebral fossa of inhomogeneous low signal intensity on T1WI, high signal intensity on T2WI with heterogeneous/dirty signal on FLAIR sequence and restricted diffusion on DWI/ADC. Thin peripheral enhancement is noted on postcontrast sequences. This lesion shows an extension through the foramen of Magendie along the posterior aspect of the medulla and bulbomedullary junction which are mildly compressed and displaced anteriorly. The 4th ventricle is compressed and displaced anteriorly. At supratentorial level, the 3rd and lateral ventricles are markedly dilated with mild periventricular interstitial edema indicating obstructive hydrocephalus.

Case Discussion

MRI features suggestive of an epidermoid cyst of the posterior cerebral fossa with obstructive hydrocephalus

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