Epidermoid cyst - obstructive hydrocephalus
Symptoms of raised intracranial pressure
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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.