Intracranial epidermoid cyst - cerebellopontine angle

Case contributed by Dr Prashant Mudgal

Presentation

Middle aged female presented with vestibular symptoms.

Patient Data

Age: 46
Gender: Female

There is a well delineated lobulated lesion that is insinuating along the basal cisterns, seen in the right cerebellopontine angle. The lesion is heterogeneous and follows CSF signal intensity on T1W and T2W imaging, partially attenuated on FLAIR and shows restricted diffusion and showing ADC similar to brain parenchyma. Post contrast scan shows no enhancement. Imaging findings are suggestive of epidermoid cyst.

The lesion is compressing the right cerebral peduncle, midbrain, pons, cerebellar hemisphere, vermis and 4th ventricle.

Case Discussion

Epidermoid cyst is the 3rd most common cerebellopontine angle tumour after schwannoma and meningioma. Closest differential of epidermoid cyst is arachnoid cyst and DWI and ADC sequences are useful in distinguishing between these two lesions. An arachnoid cyst shows no restriction of diffusion whereas an epidermoid cyst does. The ADC of arachnoid cyst is similar to stationary water, whereas the ADC of epidermoid is similar to the brain parenchyma.

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Case information

rID: 26565
Case created: 28th Dec 2013
Last edited: 5th Oct 2015
Inclusion in quiz mode: Included

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