Presentation
Headache and delirious
Patient Data
Age: 90 years
Gender: Female
From the case:
Ruptured intracranial dermoid cyst
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- small volume intra-ventricular, parafalcine and subarachnoid fat globules identified. Although windowing not performed here, the HU of the low density globules was approximately -40
- the fat within the anterior horns of the lateral ventricles creates a fat-fluid level with CSF
- no discrete lesion identified. No other intracranial abnormality
Case Discussion
Likely ruptured intracranial dermoid cyst. Possible differentials include rupture of a spinal tumor, spinal trauma and recent surgery, although there was no documented or imaging evidence of these etiologies in this patient.
Perhaps the cyst rupture had caused this patient to present and may have caused an aseptic chemical meningitis and associated delirium.
Case with thanks to Bob Zhang