Presentation
Acute headache.
From the case:
Ruptured intracranial dermoid
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A fat-density mass is seen in the interhemispheric fissure anteriorly, with multiple small droplets of similar material scattered superiorly within the subarachnoid space. These features are almost pathognomonic of a ruptured intracranial dermoid cyst, with this only alternative possibility being a mature cystic teratoma, although the absence of a solid or calcified component makes this most unlikely.
From the case:
Ruptured intracranial dermoid
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Fatty composition is confirmed on fat saturated FLAIR sequencing demonstrating complete suppression.
Case Discussion
Ruptured dermoids can mimic a clinical subarachnoid when they rupture due to the sudden onset of a headache. Identifying fatty density is the key to the diagnosis.
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