A cystic lesion in the fourth ventricle

Abstract

1. Clinical backgroundA 20-year-old woman complained of a 1-year history of intermittent generalized headache. The headache was worse in the morning, and sometimes she would wake up with nausea and vomiting. She stated that it was becoming increasingly difficult to ride her motorcycle due to weakness in both hands and she also experienced trouble with writing and using chopsticks. She developed numbness in both hands and legs and an unsteady gait. In the 2 weeks prior to admission, she developed difficulty swallowing and choked easily while eating solid foods.Plain and contrast-enahanced MRI confirmed a mass occupying the inferior 4th ventricle, near the foramen magnum. The lesion was 2.8 × 4.2 × 5.3 cm in size and had a heterogeneous signal pattern. Little enhancement was noted peripherally following the administration of contrast and no vascular structures were identified within it (Fig. 1). The contents were mainly cystic. The signal intensity of the lesion was increased on T2-weighted MRI, with a mixed low and iso-intense signal on T1-weighted MRI.2. What is the most likely diagnosis?A.Arachnoid cystB.Dermoid cystC.Epidermoid cystD.Cystic gliomaAnswer on page 1282. 1. Clinical backgroundA 20-year-old woman complained of a 1-year history of intermittent generalized headache. The headache was worse in the morning, and sometimes she would wake up with nausea and vomiting. She stated that it was becoming increasingly difficult to ride her motorcycle due to weakness in both hands and she also experienced trouble with writing and using chopsticks. She developed numbness in both hands and legs and an unsteady gait. In the 2 weeks prior to admission, she developed difficulty swallowing and choked easily while eating solid foods.Plain and contrast-enahanced MRI confirmed a mass occupying the inferior 4th ventricle, near the foramen magnum. The lesion was 2.8 × 4.2 × 5.3 cm in size and had a heterogeneous signal pattern. Little enhancement was noted peripherally following the administration of contrast and no vascular structures were identified within it (Fig. 1). The contents were mainly cystic. The signal intensity of the lesion was increased on T2-weighted MRI, with a mixed low and iso-intense signal on T1-weighted MRI. A 20-year-old woman complained of a 1-year history of intermittent generalized headache. The headache was worse in the morning, and sometimes she would wake up with nausea and vomiting. She stated that it was becoming increasingly difficult to ride her motorcycle due to weakness in both hands and she also experienced trouble with writing and using chopsticks. She developed numbness in both hands and legs and an unsteady gait. In the 2 weeks prior to admission, she developed difficulty swallowing and choked easily while eating solid foods. Plain and contrast-enahanced MRI confirmed a mass occupying the inferior 4th ventricle, near the foramen magnum. The lesion was 2.8 × 4.2 × 5.3 cm in size and had a heterogeneous signal pattern. Little enhancement was noted peripherally following the administration of contrast and no vascular structures were identified within it (Fig. 1). The contents were mainly cystic. The signal intensity of the lesion was increased on T2-weighted MRI, with a mixed low and iso-intense signal on T1-weighted MRI. 2. What is the most likely diagnosis?A.Arachnoid cystB.Dermoid cystC.Epidermoid cystD.Cystic gliomaAnswer on page 1282. A.Arachnoid cystB.Dermoid cystC.Epidermoid cystD.Cystic gliomaAnswer on page 1282. A cystic lesion in the fourth ventricleJournal of Clinical NeuroscienceVol. 18Issue 9PreviewB. Dermoid cyst. Full-Text PDF