Presentation
Headache and blurred vision.
Patient Data
Relatively well-defined lobulated altered signal intensity mass lesion, measuring 6.5 cm x 3.8 cm x 4.4 cm (AP x CC x TR), in the left suprasellar, left lateral sulcus cistern and left frontal region protruding into the left lateral ventricle. It shows heterogeneous T1W hyperintensity and heterogeneous T2W hyperintensity with partial signal suppression on T1-FS suggesting fatty and hemorrhagic components. Peripheral foci of calcification are seen. Post-contrast T1FS shows mild peripheral rim enhancement.
Restricted diffusion is seen within the mass on DWI and ADC mapping.
T1 hyperintensity with chemical-shift artefact at the tip of the left frontal horn suggests fat-CSF level. Fat signal intensity in the left paramedian frontal sulcal space.
Findings are consistent with ruptured intracranial dermoid cyst. It is causing marked mass effect with hydrocephalus and leftward midline shift. Mass effect is seen over left optic chiasma which show T2 hyperintense signal intensity.
Case Discussion
Intracranial dermoid cysts are rare and generally benign congenital lesions but may cause acute complications such as chemical meningitis or hydrocephalus if they rupture. They are typically present in first three decades of life. They occur mostly in the midline suprasellar region followed by posterior fossa and spine. Typically they show high T1W signal intensity, chemical shift artefact, variable signal intensity on T2WI and little or no peripheral enhancement.
They appear as hypodense on CT due to fat components. Peripheral foci of calcification may be seen.
High signal intensity in the subarachnoid spaces and ventricles on T1WI is suggestive of rupture of dermoid cyst.
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