Abstract
Intracranial dermoid cysts are congenital, usually nonmalignant lesions with an incidence of 0.5% of all intracranial tumors. They tend to occur in the midline sellar, parasellar, or frontonasal regions. Although theirnature is benign, dermoid cysts have a high morbidity and mortality risk, especially when rupture occurs. A 40 year old woman presented with head injury after she experienced sudden loss of consciousness. She hada history of headache, loss of consciousness; her past medical history was not remarkable. The patient had no complaints of nausea, vomiting, or seizures. Vital signs were stable, neurologic defi cit was not identifi ed.Computed tomography (CT) and magnetic resonance imaging (MRI) showed right temporobasal zone with fat droplets within right fi ssure Sylvii and interhemispheric fi ssure indicating a rupture of a dermoid cyst. Craniotomy and cyst resection were done, and diagnosis was confirmed with pathological examination following surgery. After surgery the patient did not recover. Cerebral ischemia from chemical meningitis was fatal forour patient. Headache as a symptom has many causes. It is rarely due to chemical meningitis arising from a ruptured dermoid cyst. This case report illustrated the importance of investigating a cause of the headache,CT and MRI being diagnostic methods. In this way, mortality as well as morbidity from complications such as chemical arachnoiditis can be significantly reduced if imaging is done early in these patients.
Highlights
Intracranial dermoid cysts are rare, congenital, usually benign lesions
Rupture leads to aseptic chemical meningitis, vasospasm, cerebral ischemia and coma (1, 2)
We present computed tomography (CT) and magnetic resonance imaging (MRI) findings of a ruptured intracranial dermoid cyst with postoperative complications
Summary
Intracranial dermoid cysts are rare, congenital, usually benign lesions. They are usually detected accidentally but often become symptomatic after rupture. Rupture leads to aseptic chemical meningitis, vasospasm, cerebral ischemia and coma (1, 2). Chemical meningitis may lead to transient cerebral ischemia secondary to vasospasm with complicating infarction and the death of the patient (3), as happened in our case. We present CT and MRI findings of a ruptured intracranial dermoid cyst with postoperative complications. CT showed tiny, partially confluent, low attenuation areas of fat density within right fissure Sylvii and interhemispheric fissure (Figure 2). The appearance of fat droplets usually follows rupture of a dermoid cyst. MRI scan confirmed CT diagnosis of a ruptured dermoid cyst, and the patient was referred for a neurosurgical opinion.
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