Presentation
Headache.
Patient Data
A well-defined, extra-axial low-density lesion of near CSF attenuation is noted in the right quadrigeminal cistern region. The lesion has a scalloped posterior aspect of the midbrain and right cerebellar hemisphere. The fourth ventricle is displaced towards the left, with convincing evidence of hydrocephalus. There is no solid component.
Periventricular low attenuation in keeping with trans-ependymal edema also is noted.
A well-delineated lesion is noted in the right quadrigeminal cisterns. 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. The Post-contrast scan shows no enhancement.
The lesion is compressing the right cerebellar hemisphere, midbrain, and fourth ventricle leading to obstructive hydrocephalus.
Periventricular high signal intensity on T2W and FLIAR and low signal intensity on T1W inconsistent with trans-ependymal edema also is noted.
A right sphenoid wing meningioma measuring 10×13 mm is seen.
Case Discussion
This case demonstrates typical appearances of an intracranial epidermoid cyst.
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