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Quadrigeminal cistern lipoma

Case contributed by Mostafa Elfeky
Diagnosis almost certain

Presentation

Known case of systemic lupus erythematosus presented with headache. The patient also complained some visual and auditory disturbances.

Patient Data

Age: 30 years
Gender: Female
mri

Crescent-shaped extra-axial esion capping the posteroinferior aspect of the quadrigeminal plate is noted insinuating itself in-between the quadrigeminal plate of the mid-brain anteriorly and the superior vermis of the cerebellum posteriorly. It is measuring 4 x 11.5 x 11 mm in AP, TS and CC dimensions respectively.

It showed marked T1 pre-contrast high signals and T2 high signals as well with complete suppression on fat-suppressed sequences. Evident blooming in SWI noted.

The lesion is exerting mild indentation of the inferior colliculus of the tectum of the midbrain and to a lesser extent the superior colliculus (Auditory and visual complaints could be explained).

No restricted diffusion or surrounding edema.

Case Discussion

Quadrigeminal cistern lipoma is the second common site for intracranial lipomas after pericallosal lipoma. It is often incidentally detected by computed tomography or MRI. It is usually asymptomatic and a slow-growing lesion which rarely requires surgery 1.

Intracranial lipomas can produce susceptibility artifact that makes it appear dark or bloomed on SWI sequence and so shouldn't be confused with cisternal hemorrhage 2. SWI and fat-saturated sequences are the best sequences to differentiate it from subarachnoid hemorrhage which produces no suppression on fat-suppressed sequences and more blooming size than actual lesion size unlike susceptibility artifact.

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