Intracranial epidermoid cyst - cerebellopontine angle
Middle aged female presented with vestibular symptoms.
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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.
1 case question available
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.