Answer for BIR CoW 29 July 2018
RUPTURED EPIDERMOID CYST
Findings
T1 hypointense, T2 hyperintense lesion noted within the left lateral ventricle displacing the septum pellucidum to right, partially suppressed in FLAIR. The lesion shows diffusion restriction & no enhancement with contrast. It measures 5.5 (AP) x 5 (transverse) x 6.7 (cranio caudal) cm Multiple foci of diffusion restriction noted in temporal horn of bilateral lateral ventricle, occipital horn of right lateral ventricle. Features suggestive of ruptured epidermoid cyst – left lateral ventricle.
Discussion
Intracranial epidermoid cyst are common congenital lesions accounting for 1 % of all intracranial tumours. They result from inclusion of ectodermal elements during neural tube closure . They typically presnt in middle age due to mass effect. Their content – desquamated epithelial cells mimics CSF on CT nad MRI, except DW I which shows restricted diffusion. CURRARINO TRIAD : Uncommon Association With Anoractal, Sacral Anomalies And Presacral Masses . SYMPTOMS Most common : headache Cranial nerve deficits Cerebellar symptoms Seizzures Raised ICT LOCATION 90% - INTRADURAL ; 10 % EXTRADURAL Among Intradural location, 40 – 50 % occur in cerebello-pontine angle. Other location include suprasellar cistern , 4th ventricle , middle cranial fossa RADIOLOGICAL FEATURES Appear as lobulated lesions that fill and expand CSF spaces and exert a gradual mass effect , insinuating between structures and encasing nerves and vessels. CT : Cellular Debris Along With High Cholestrol Content Lower The Density To 0 HU ( identical to CSF).Rarely May Be Hyperdense Due To Hemorrhage , saponification or high protein content. MRI : T1 – Isointense To Csf T2 – Isointense To Csf FLAIR – heterogenous dirty signal DWI – Restricted Diffusion CONTRAST - enhancement only in periphery ; pronounced in malignant degeneration
REFERENCES Radiopedia.org www.hindawi.com Ispub.com www.ajnr.org Medscape.com
Findings
T1 hypointense, T2 hyperintense lesion noted within the left lateral ventricle displacing the septum pellucidum to right, partially suppressed in FLAIR. The lesion shows diffusion restriction & no enhancement with contrast. It measures 5.5 (AP) x 5 (transverse) x 6.7 (cranio caudal) cm Multiple foci of diffusion restriction noted in temporal horn of bilateral lateral ventricle, occipital horn of right lateral ventricle. Features suggestive of ruptured epidermoid cyst – left lateral ventricle.
Discussion
Intracranial epidermoid cyst are common congenital lesions accounting for 1 % of all intracranial tumours. They result from inclusion of ectodermal elements during neural tube closure . They typically presnt in middle age due to mass effect. Their content – desquamated epithelial cells mimics CSF on CT nad MRI, except DW I which shows restricted diffusion. CURRARINO TRIAD : Uncommon Association With Anoractal, Sacral Anomalies And Presacral Masses . SYMPTOMS Most common : headache Cranial nerve deficits Cerebellar symptoms Seizzures Raised ICT LOCATION 90% - INTRADURAL ; 10 % EXTRADURAL Among Intradural location, 40 – 50 % occur in cerebello-pontine angle. Other location include suprasellar cistern , 4th ventricle , middle cranial fossa RADIOLOGICAL FEATURES Appear as lobulated lesions that fill and expand CSF spaces and exert a gradual mass effect , insinuating between structures and encasing nerves and vessels. CT : Cellular Debris Along With High Cholestrol Content Lower The Density To 0 HU ( identical to CSF).Rarely May Be Hyperdense Due To Hemorrhage , saponification or high protein content. MRI : T1 – Isointense To Csf T2 – Isointense To Csf FLAIR – heterogenous dirty signal DWI – Restricted Diffusion CONTRAST - enhancement only in periphery ; pronounced in malignant degeneration
REFERENCES Radiopedia.org www.hindawi.com Ispub.com www.ajnr.org Medscape.com
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!