Presentation
Incidental lesion on CT.
Patient Data
There is an extra-axial intrinsic T1 hyperintense lesion to the left of the vermis of the cerebellum expanding the paravermian cistern, does not enhance, demonstrates blooming on susceptibility weighted imaging and it is hypointense on DWI. There is some associated atrophy of the left aspect of the vermis. The lesion wraps around the left superior cerebellar peduncle and has a small component extending into the superior left aspect of the fourth ventricle. Also, there is the apeparances of an encased vessel within the lesion. The ventricle is otherwise normal in size. The remainder of the brain is normal in appearance with no other intra or extra-axial mass or collection. The remainder of the ventricular and sulcal pattern is within normal limits.
Case Discussion
This case shows a paravermian lesion that definitely has benign features. Intracranial lipomas have been described having associated susceptibility artefacts. Also, the appearances of the lesion encasing a vessel are supportive for this diagnosis.
In summary, the lesion is favored to represent an intracranial lipoma, a dermoid cyst is felt a less likely but possible differential.
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