The Journal of Radiology Case Reports - interactive Radiology case reports and Radiology review articles

Journal of Radiology Case Reports

Ruptured intracranial dermoid cyst manifesting as new onset seizure: a case report

Case Report

Jennifer Neville Kucera1, Pinakpani Roy2*, Ryan Murtagh3

Radiology Case. 2011 Apr; 5(4):10-18 :: DOI: 10.3941/jrcr.v5i4.592

Cite this paper

1. Department of Radiology, University of South Florida College of Medicine, Tampa, FL, USA
2. University of South Florida College of Medicine, Tampa, FL, USA
3. Department of Radiology, Moffitt Cancer Center, Tampa, FL, USA

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  ABSTRACT
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Intracranial dermoid cysts are rare tumors derived from ectopic epithelial cells. They are slow-growing benign entities, but can cause significant morbidity through compression of neurovascular structures and, rarely, rupture into the subarachnoid space. We present a rare case of a spontaneously ruptured intracranial dermoid cyst presenting as new onset seizures due to chemical meningitis caused by dissemination of fat droplets.








  CASE REPORT
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A 19-year-old male presented to the ER with a history of 2 episodes of new onset seizures. Both were complex partial seizures involving lower extremity spasms prior to loss of consciousness. On presentation, the patient had a normal physical exam, including a complete neurological and cranial nerve exam.

CT of the brain (Fig. 1 Preview this figure

Figure 1: Computed Tomography
Non-Contrast CT. 19 year old male with ruptured intracranial dermoid cyst. Axial non-contrast CT images of the head demonstrate a large low-density suprasellar lesion (asterisk). Numerous low-density fat droplets are seen in the subarachnoid space. Slice Thickness: 5.0, FOV: 24 X 24 cm, W: 80, L: 40, KVP = 120, mAs = 450
) revealed a large low-density (-25 HU) suprasellar lesion causing widening of the interpeduncular cistern. Numerous low-density fat droplets were noted in the subarachnoid space.

Subsequent MRI (Fig. 2 Preview this figure
Figure 2: Magnetic Resonance Imaging
MRI T1 sequence Axial. 19 year old male with ruptured intracranial dermoid cyst. Axial MRI (1.5 Tesla magnet) T1 weighted image demonstrates a suprasellar mass of high T1 signal intensity (asterisk), which causes widening of the interpeduncular cistern. Scattered droplets (arrows) of similar signal characteristics were noted in the subarachnoid space. T1 Axial parameters: TR = 400, TE = 14, Slice Thickness = 5 mm, FOV = 24 X 24 cm, Magnet strength: 1.5 Tesla
-Fig. 13 Preview this figure
Figure 13: Magnetic Resonance Imaging
MRI T1 sequence Post Contrast Axial image with fat suppression. 19 year old male with ruptured intracranial dermoid cyst. Axial MRI (1.5 Tesla magnet) T1 weighted post contrast image with fat suppression demonstrates mild leptomeningeal enhancement, most prominent in the frontal regions. Contrast: 16 cc Magnevist, TR = 510, TE = 17, Slice Thickness = 5 mm, FOV = 19.5 X 19.5 cm, Magnet strength: 1.5 Tesla
) of the brain revealed a non-enhancing suprasellar mass partially encasing the right internal carotid artery. The mass was of high T1 and T2 signal with signal dropout on fat suppression imaging. Scattered droplets with similar signal characteristics were noted in a fronto-temporal spread within the subarachnoid space. The mass was hyperintense on DWI, but demonstrated an ADC that was similar to brain parenchyma (Fig. 10 Preview this figure
Figure 10: Magnetic Resonance Imaging
MRI DWI image. 19 year old male with ruptured intracranial dermoid cyst. The mass is denoted by an asterisk. A hyperintense signal is noted in the diffusion weighted images (DWI), whereas the Apparent Diffusion Coefficient (ADC) of the mass is isointense with brain parenchyma (figure 11). TR = 3800, TE = 102, Slice Thickness = 5 mm, FOV = 19.5 X 19.5 cm, Magnet strength: 1.5 Tesla
-Fig. 11 Preview this figure
Figure 11: Magnetic Resonance Imaging
MRI ADC image. 19 year old male with ruptured intracranial dermoid cyst. The mass is denoted by an asterisk. A hyperintense signal is noted in the diffusion weighted images (DWI, figure 10), whereas the Apparent Diffusion Coefficient (ADC) of the mass is isointense with brain parenchyma. TR = 3800, TE = 102, Slice Thickness = 5 mm, FOV = 19.5 X 19.5 cm, Magnet strength: 1.5 Tesla
). In addition, mild leptomeningeal enhancement was noted on the post-contrast images (Fig. 13 Preview this figure
Figure 13: Magnetic Resonance Imaging
MRI T1 sequence Post Contrast Axial image with fat suppression. 19 year old male with ruptured intracranial dermoid cyst. Axial MRI (1.5 Tesla magnet) T1 weighted post contrast image with fat suppression demonstrates mild leptomeningeal enhancement, most prominent in the frontal regions. Contrast: 16 cc Magnevist, TR = 510, TE = 17, Slice Thickness = 5 mm, FOV = 19.5 X 19.5 cm, Magnet strength: 1.5 Tesla
).

Given the clinical history and the MRI demonstration of disseminated particles, a ruptured intracranial mass seemed most likely. The signal characteristics of the mass on T1 and DWI, coupled with the insidious clinical history steered us towards the diagnosis of an intracranial dermoid cyst.
The patient was placed on anticonvulsant therapy, and on follow-up visits at 4 and 10 months he was noted to be neurologically asymptomatic with no further seizures. Follow-up imaging (Fig. 14 Preview this figure
Figure 14: Magnetic Resonance Imaging
4-month Follow up Imaging. MRI T1 sequence Post Contrast Sagittal image. 19 year old male with ruptured intracranial dermoid cyst. 4 month followup images. Sagittal MRI (1.5 Tesla magnet) T1 weighted post contrast image again demonstrates suprasellar mass (asterisk) with scattered droplets in the fronto-parietal (arrows) subarachnoid space. This was unchanged from the prior examination. Contrast: 16 cc Magnevist, TR = 435, TE = 15, Slice Thickness = 5 mm, FOV = 19.5 X 19.5 cm, Magnet strength: 1.5 Tesla
) remained unchanged.

  DISCUSSION
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Abstract
Case Report
Discussion
Teaching Point
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Intracranial dermoid cysts are rare, comprising 0.04-0.7% of intracranial tumors [1]. They are derived from ectopic epithelial cells that are part of the neural tube, which also explains their typical location close to the midline [2]. Although they are benign, slow-growing tumors, they may cause focal neurologic signs through encroachment of neurovascular structures and, rarely, rupture [3]. Dermoid cysts contain lipid material [4], and previous reports have discussed that they may have fatty tissue peripherally and fluid centrally [5]. They can contain hair follicles, sebaceous and sweat glands, and the presence of these structures helps distinguish a dermoid from the more common epidermoid cysts [6]. They are not true neoplasms, as they enlarge through accumulation of desquamation products and sebaceous secretions inside a cystic cavity [7] rather than via cell division.

Rupture of intracranial dermoid cysts is a rare phenomenon (5 out of 2707, or 0.18% of all new CNS tumors operated on during a 12-year period at a major tertiary care center) [8] and typically spontaneous, although can occur secondary to closed head trauma [9]. The pathophysiology behind spontaneous rupture is not clearly understood, and hypotheses have implicated glandular secretions caused by age-dependent hormones [6] as well as head movements and brain pulsations [10]. The dissemination of intracystic keratin and cholesterol breakdown products [11] following rupture can cause a wide variety of symptoms ranging from headache to hallucinations [12,13,14,15]. Clinical presentation can vary depending on the cyst location, and in one analysis of available case reports by El-Bahy et al. [16] headache was the most common symptom (32.6%), followed by seizures (26.5%), cerebral ischemia with sensory and/or motor hemisyndrome (16.3%), and aseptic meningitis (8.2%). The case presented involved a spontaneously ruptured intracranial dermoid cyst causing new onset seizures due to presumed chemical meningitis and chemical irritation secondary to dissemination of fat droplets.

On CT scans, dermoid cysts can have mixed densities [8], and rarely enhance following contrast administration [17,18,19]. The intracystic fat and disseminated fat droplets appears hypodense, whereas calcifications in the wall are hyperdense. Hydrocephalus and fat-fluid level may be present following rupture into the ventricular system. On MRI, dermoid cysts are hyperintense on T1-weighted sequences and variable on T2-weighted sequences, although the presence of cholesterol can often make them appear hypointense on T2 as well [17,20]. Dermoid cysts can be differentiated from epidermoid cysts in that the former demonstrates fat signal on CT and MRI whereas the latter resembles CSF [21]. Although Fluid Attenuated Inversion Recovery (FLAIR) sequences and Diffusion Weighted Imaging (DWI) have been used to distinguish the two entities, dermoid cysts can resemble epidermoids due to their bright signal on DWI [22,23].

MRI is more sensitive than CT in the detection of dermoid cysts and due to the higher contrast resolution, the ease of multiplanar imaging and the lack of bone artifacts [24]. Orakcoiglu et. al. [25] in particular emphasizes the importance of using an MRI protocol involving T2-WI, T1-WI, T1 fat saturated-WI, Magnetic Resonance Angiography (MRA) and DWI. Conventional MRI is not very helpful in distinguishing dermoids from other cystic masses such as arachnoid cysts. On DWI, however, the dermoids are hyperintense to brain parenchyma, but demonstrate an ADC that is similar to that of parenchyma and CSF. This is in contrast to arachnoid cysts, which show the opposite pattern (low DWI, but elevated ADC) [26,27]. Differentiating a dermoid cyst from craniopharyngiomas is relatively easier, as the latter enhances strongly on CT [28,29]. In addition, the craniopharyngioma cyst walls also display strong enhancement on T1-weighted MRI sequences [30,31]. Teratomas help distinguish themselves via their calcifications, which are hyperintense on CT [32, 33] and show up as shadowing echogenic foci on ultrasound [34].

Dermoid cysts are benign entities, and have a generally favorable prognosis. Surgery is only indicated in cases where dermoid cysts cause mass effect and serious neurological deficits. In cases where the cyst is intact, the goal is complete surgical removal of the primary tumor capsule and intracystic contents and dissection from adjacent neurovascular structures [7,10]. Unfortunately, dissemination of fat droplets following rupture is usually too extensive to allow for complete removal. However, Liu et. al. [8] and others [35,36] have shown that long-term monitoring with serial MRI scans and clinical examinations of patients with extensive disseminated fat particles has not demonstrated progression or movement of the fat or new neurological deterioration. In those cases, medical management is indicated for symptom control.

  TEACHING POINT
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Abstract
Case Report
Discussion
Teaching Point
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References
Abbreviations
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Intracranial dermoid cysts are benign rare slow-growing tumors that, when intact, are of mixed or predominantly low density on CT and hyperintense on MRI T1 with little to no contrast enhancement. The cysts are hyperintense on DWI and isointense to brain parenchyma on ADC, which helps distinguish them from other cystic masses. Upon rupture, however, widespread presence of T1 hyperintense droplets and leptomeningeal enhancement can be noted - making MRI the best imaging modality for diagnosis of this rare entity.








  FIGURES
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Display figure 1 in original size

Figure 1: Non-Contrast CT. 19 year old male with ruptured intracranial dermoid cyst. Axial non-contrast CT images of the head demonstrate a large low-density suprasellar lesion (asterisk). Numerous low-density fat droplets are seen in the subarachnoid space. Slice Thickness: 5.0, FOV: 24 X 24 cm, W: 80, L: 40, KVP = 120, mAs = 450

Figure 1: Computed Tomography (Open in original size)
Non-Contrast CT. 19 year old male with ruptured intracranial dermoid cyst. Axial non-contrast CT images of the head demonstrate a large low-density suprasellar lesion (asterisk). Numerous low-density fat droplets are seen in the subarachnoid space. Slice Thickness: 5.0, FOV: 24 X 24 cm, W: 80, L: 40, KVP = 120, mAs = 450

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Display figure 2 in original size
Figure 2: MRI T1 sequence Axial. 19 year old male with ruptured intracranial dermoid cyst. Axial MRI (1.5 Tesla magnet) T1 weighted image demonstrates a suprasellar mass of high T1 signal intensity (asterisk), which causes widening of the interpeduncular cistern. Scattered droplets (arrows) of similar signal characteristics were noted in the subarachnoid space. T1 Axial parameters: TR = 400, TE = 14, Slice Thickness = 5 mm, FOV = 24 X 24 cm, Magnet strength: 1.5 Tesla

Figure 2: Magnetic Resonance Imaging (Open in original size)
MRI T1 sequence Axial. 19 year old male with ruptured intracranial dermoid cyst. Axial MRI (1.5 Tesla magnet) T1 weighted image demonstrates a suprasellar mass of high T1 signal intensity (asterisk), which causes widening of the interpeduncular cistern. Scattered droplets (arrows) of similar signal characteristics were noted in the subarachnoid space. T1 Axial parameters: TR = 400, TE = 14, Slice Thickness = 5 mm, FOV = 24 X 24 cm, Magnet strength: 1.5 Tesla

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Display figure 3 in original size
Figure 3: MRI T1 sequence Axial. Axial MRI (1.5 Tesla magnet) image of a 19 year old male with ruptured intracranial dermoid cyst. This image demonstrates partial encasement of the right ICA (arrow) by the mass. T1 Axial parameters: TR = 400, TE = 14, Slice Thickness = 5 mm, FOV = 24 X 24 cm, Magnet strength: 1.5 Tesla

Figure 3: Magnetic Resonance Imaging (Open in original size)
MRI T1 sequence Axial. Axial MRI (1.5 Tesla magnet) image of a 19 year old male with ruptured intracranial dermoid cyst. This image demonstrates partial encasement of the right ICA (arrow) by the mass. T1 Axial parameters: TR = 400, TE = 14, Slice Thickness = 5 mm, FOV = 24 X 24 cm, Magnet strength: 1.5 Tesla

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Display figure 4 in original size
Figure 4: MRI T1 sequence Axial. 19 year old male with ruptured intracranial dermoid cyst. Axial MRI (1.5 Tesla magnet) T1 weighted image demonstrates scattered droplets (arrows) of high T1 signal in the fronto-temporal subarachnoid space. T1 Axial parameters: TR = 400, TE = 14, Slice Thickness = 5 mm, FOV = 24 X 24 cm, Magnet strength: 1.5 Tesla

Figure 4: Magnetic Resonance Imaging (Open in original size)
MRI T1 sequence Axial. 19 year old male with ruptured intracranial dermoid cyst. Axial MRI (1.5 Tesla magnet) T1 weighted image demonstrates scattered droplets (arrows) of high T1 signal in the fronto-temporal subarachnoid space. T1 Axial parameters: TR = 400, TE = 14, Slice Thickness = 5 mm, FOV = 24 X 24 cm, Magnet strength: 1.5 Tesla

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Display figure 5 in original size
Figure 5: MRI T1 sequence Coronal. 19 year old male with ruptured intracranial dermoid cyst. Coronal MRI (1.5 Tesla magnet) T1 weighted image demonstrate suprasellar mass (asterisk) of high T1 signal. Scattered fat droplets (arrows) are re-identified. T1 Coronal parameters: TR = 446, TE = 13, Slice Thickness = 3 mm, FOV = 18 X 18 cm, Magnet strength: 1.5 Tesla

Figure 5: Magnetic Resonance Imaging (Open in original size)
MRI T1 sequence Coronal. 19 year old male with ruptured intracranial dermoid cyst. Coronal MRI (1.5 Tesla magnet) T1 weighted image demonstrate suprasellar mass (asterisk) of high T1 signal. Scattered fat droplets (arrows) are re-identified. T1 Coronal parameters: TR = 446, TE = 13, Slice Thickness = 3 mm, FOV = 18 X 18 cm, Magnet strength: 1.5 Tesla

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Display figure 6 in original size
Figure 6: MRI T1 sequence Sagittal. 19 year old male with ruptured intracranial dermoid cyst. Sagittal MRI (1.5 Tesla magnet) T1 weighted image demonstrates a suprasellar mass (asterisk) of high T1 signal and scattered droplets (arrows) throughout the subarachnoid space of similar signal characteristics. T1 Sagittal parameters: TR = 453, TE = 12, Slice Thickness = 5 mm, FOV = 26 X 26 cm, Magnet strength: 1.5 Tesla

Figure 6: Magnetic Resonance Imaging (Open in original size)
MRI T1 sequence Sagittal. 19 year old male with ruptured intracranial dermoid cyst. Sagittal MRI (1.5 Tesla magnet) T1 weighted image demonstrates a suprasellar mass (asterisk) of high T1 signal and scattered droplets (arrows) throughout the subarachnoid space of similar signal characteristics. T1 Sagittal parameters: TR = 453, TE = 12, Slice Thickness = 5 mm, FOV = 26 X 26 cm, Magnet strength: 1.5 Tesla

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Display figure 7 in original size
Figure 7: MRI T1 sequence Sagittal. 19 year old male with ruptured intracranial dermoid cyst. Sagittal MRI T1 weighted image demonstrates a suprasellar mass (asterisk) of high T1 signal and scattered droplets (arrows) throughout the subarachnoid space of similar signal characteristics. T1 Sagittal parameters: TR = 453, TE = 12, Slice Thickness = 5 mm, FOV = 26 X 26 cm, Magnet strength: 1.5 Tesla

Figure 7: Magnetic Resonance Imaging (Open in original size)
MRI T1 sequence Sagittal. 19 year old male with ruptured intracranial dermoid cyst. Sagittal MRI T1 weighted image demonstrates a suprasellar mass (asterisk) of high T1 signal and scattered droplets (arrows) throughout the subarachnoid space of similar signal characteristics. T1 Sagittal parameters: TR = 453, TE = 12, Slice Thickness = 5 mm, FOV = 26 X 26 cm, Magnet strength: 1.5 Tesla

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Display figure 8 in original size
Figure 8: MRI T2 sequence Axial. 19 year old male with ruptured intracranial dermoid cyst. Axial MRI (1.5 Tesla magnet) T2 weighted image demonstrates a suprasellar mass of high T2 signal intensity (asterisk), which causes widening of the interpeduncular cistern. T2 Axial parameters: TR = 4790, TE = 113, Slice Thickness = 5 mm, FOV = 23.8 X 24 cm, Magnet strength: 1.5 Tesla

Figure 8: Magnetic Resonance Imaging (Open in original size)
MRI T2 sequence Axial. 19 year old male with ruptured intracranial dermoid cyst. Axial MRI (1.5 Tesla magnet) T2 weighted image demonstrates a suprasellar mass of high T2 signal intensity (asterisk), which causes widening of the interpeduncular cistern. T2 Axial parameters: TR = 4790, TE = 113, Slice Thickness = 5 mm, FOV = 23.8 X 24 cm, Magnet strength: 1.5 Tesla

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Display figure 9 in original size
Figure 9: MRI T2 sequence Axial. 19 year old male with ruptured intracranial dermoid cyst. Axial MRI (1.5 Tesla magnet) T2 FLAIR image demonstrates a suprasellar mass of low FLAIR signal intensity (asterisk), which causes widening of the interpeduncular cistern. FLAIR Axial parameters: FLAIR TR = 8480, TE = 98, Slice Thickness = 5 mm, FOV = 23.8 X 24 cm, Magnet strength: 1.5 Tesla

Figure 9: Magnetic Resonance Imaging (Open in original size)
MRI T2 sequence Axial. 19 year old male with ruptured intracranial dermoid cyst. Axial MRI (1.5 Tesla magnet) T2 FLAIR image demonstrates a suprasellar mass of low FLAIR signal intensity (asterisk), which causes widening of the interpeduncular cistern. FLAIR Axial parameters: FLAIR TR = 8480, TE = 98, Slice Thickness = 5 mm, FOV = 23.8 X 24 cm, Magnet strength: 1.5 Tesla

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Display figure 10 in original size
Figure 10: MRI DWI image. 19 year old male with ruptured intracranial dermoid cyst. The mass is denoted by an asterisk. A hyperintense signal is noted in the diffusion weighted images (DWI), whereas the Apparent Diffusion Coefficient (ADC) of the mass is isointense with brain parenchyma (figure 11). TR = 3800, TE = 102, Slice Thickness = 5 mm, FOV = 19.5 X 19.5 cm, Magnet strength: 1.5 Tesla

Figure 10: Magnetic Resonance Imaging (Open in original size)
MRI DWI image. 19 year old male with ruptured intracranial dermoid cyst. The mass is denoted by an asterisk. A hyperintense signal is noted in the diffusion weighted images (DWI), whereas the Apparent Diffusion Coefficient (ADC) of the mass is isointense with brain parenchyma (figure 11). TR = 3800, TE = 102, Slice Thickness = 5 mm, FOV = 19.5 X 19.5 cm, Magnet strength: 1.5 Tesla

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Display figure 11 in original size
Figure 11: MRI ADC image. 19 year old male with ruptured intracranial dermoid cyst. The mass is denoted by an asterisk. A hyperintense signal is noted in the diffusion weighted images (DWI, figure 10), whereas the Apparent Diffusion Coefficient (ADC) of the mass is isointense with brain parenchyma. TR = 3800, TE = 102, Slice Thickness = 5 mm, FOV = 19.5 X 19.5 cm, Magnet strength: 1.5 Tesla

Figure 11: Magnetic Resonance Imaging (Open in original size)
MRI ADC image. 19 year old male with ruptured intracranial dermoid cyst. The mass is denoted by an asterisk. A hyperintense signal is noted in the diffusion weighted images (DWI, figure 10), whereas the Apparent Diffusion Coefficient (ADC) of the mass is isointense with brain parenchyma. TR = 3800, TE = 102, Slice Thickness = 5 mm, FOV = 19.5 X 19.5 cm, Magnet strength: 1.5 Tesla

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Display figure 12 in original size
Figure 12: MRI T1 sequence Post Contrast Axial image with fat suppression. 19 year old male with ruptured intracranial dermoid cyst. Axial MRI (1.5 Tesla magnet) T1 weighted post contrast image with fat suppression demonstrates a non-enhancing suprasellar mass (asterisk) with signal dropout on fat suppression imaging. There is mild peripheral enhancement of the mass, as denoted by the arrow. Contrast: 16 cc Magnevist, TR = 417, TE = 17, Slice Thickness = 5 mm, FOV = 19.5 X 19.5 cm, Magnet strength: 1.5 Tesla

Figure 12: Magnetic Resonance Imaging (Open in original size)
MRI T1 sequence Post Contrast Axial image with fat suppression. 19 year old male with ruptured intracranial dermoid cyst. Axial MRI (1.5 Tesla magnet) T1 weighted post contrast image with fat suppression demonstrates a non-enhancing suprasellar mass (asterisk) with signal dropout on fat suppression imaging. There is mild peripheral enhancement of the mass, as denoted by the arrow. Contrast: 16 cc Magnevist, TR = 417, TE = 17, Slice Thickness = 5 mm, FOV = 19.5 X 19.5 cm, Magnet strength: 1.5 Tesla

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Display figure 13 in original size
Figure 13: MRI T1 sequence Post Contrast Axial image with fat suppression. 19 year old male with ruptured intracranial dermoid cyst. Axial MRI (1.5 Tesla magnet) T1 weighted post contrast image with fat suppression demonstrates mild leptomeningeal enhancement, most prominent in the frontal regions. Contrast: 16 cc Magnevist, TR = 510, TE = 17, Slice Thickness = 5 mm, FOV = 19.5 X 19.5 cm, Magnet strength: 1.5 Tesla

Figure 13: Magnetic Resonance Imaging (Open in original size)
MRI T1 sequence Post Contrast Axial image with fat suppression. 19 year old male with ruptured intracranial dermoid cyst. Axial MRI (1.5 Tesla magnet) T1 weighted post contrast image with fat suppression demonstrates mild leptomeningeal enhancement, most prominent in the frontal regions. Contrast: 16 cc Magnevist, TR = 510, TE = 17, Slice Thickness = 5 mm, FOV = 19.5 X 19.5 cm, Magnet strength: 1.5 Tesla

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Display figure 14 in original size
Figure 14: 4-month Follow up Imaging. MRI T1 sequence Post Contrast Sagittal image. 19 year old male with ruptured intracranial dermoid cyst. 4 month followup images. Sagittal MRI (1.5 Tesla magnet) T1 weighted post contrast image again demonstrates suprasellar mass (asterisk) with scattered droplets in the fronto-parietal (arrows) subarachnoid space. This was unchanged from the prior examination. Contrast: 16 cc Magnevist, TR = 435, TE = 15, Slice Thickness = 5 mm, FOV = 19.5 X 19.5 cm, Magnet strength: 1.5 Tesla

Figure 14: Magnetic Resonance Imaging (Open in original size)
4-month Follow up Imaging. MRI T1 sequence Post Contrast Sagittal image. 19 year old male with ruptured intracranial dermoid cyst. 4 month followup images. Sagittal MRI (1.5 Tesla magnet) T1 weighted post contrast image again demonstrates suprasellar mass (asterisk) with scattered droplets in the fronto-parietal (arrows) subarachnoid space. This was unchanged from the prior examination. Contrast: 16 cc Magnevist, TR = 435, TE = 15, Slice Thickness = 5 mm, FOV = 19.5 X 19.5 cm, Magnet strength: 1.5 Tesla

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Display figure 15 in original size
Figure 15: Differential diagnosis table for intracranial dermoid cyst
References used for differential table: Craniopharyngioma: 28-31, Teratoma: 32-34, Epidermoid cyst: 37-41

Figure 15: Table (Open in original size)
Differential diagnosis table for intracranial dermoid cyst
References used for differential table: Craniopharyngioma: 28-31, Teratoma: 32-34, Epidermoid cyst: 37-41

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Display figure 16 in original size
Figure 16: Summary table for intracranial dermoid cyst

Figure 16: Table (Open in original size)
Summary table for intracranial dermoid cyst

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  REFERENCES
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Abstract
Case Report
Discussion
Teaching Point
Figures
References
Abbreviations
More Images
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CT = Computed Tomography
MRI = Magnetic Resonance Imaging
FLAIR = Fluid Attenuated Inversion Recovery
DWI = Diffusion Weighted Imaging
MRA = Magnetic Resonance Angiography








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