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Dermoid cyst, ruptured

CLINICAL HISTORY:
A 20-year old female patient presented with acute onset of general headache and vomiting necessitating hospital admission. The headache persisted for a few days and decreased progressively.

NEUROLOGICAL EXAMINATION is normal.

NON-CONTRAST CT (IMAGES 1 AND 2) shows a fat containing tumor (arrow) with negative attenuation values of -80 Hounsfield Units in the left inferior frontal region. There are widespread similarly low-density foci (arrowheads) in the basal cisterns and the subarachnoid spaces.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGES 3 AND 4): The tumor (arrow) is inhomogeneously hyperintense, while the subarachnoid foci are hypointense (arrowheads).

b)TRANSAXIAL T1-WEIGHTED (600/15/1) SPIN-ECHO SEQUENCE (IMAGES 5 - 6 - 7): The majority of the mass (arrow) is hyperintense, except for the medial part. The subarachnoid foci are strongly hyperintense.

RADIOLOGICAL DIAGNOSIS is ruptured dermoid cyst, based on the typical fat density on CT, the T1 and T2 shortening and the subarachnoid location of the fat drops.

SURGICAL FINDINGS: A cyst containing fat tissue and whorls of hair was removed. A large tear was present at the anterior aspect of the lesion. In the vicinity of the tumor fat was adherent to the cerebral surface of the dura.

ANATOMOPATHOLOGY (IMAGE 8) confirmed dermoid cyst.

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Fig. 1

Dermoid cyst, ruptured, Fig. 1
Dermoid cyst, ruptured, Fig. 2
Dermoid cyst, ruptured, Fig. 3
Dermoid cyst, ruptured, Fig. 4
Dermoid cyst, ruptured, Fig. 5