Epidermoid cyst (4th ventricle)

Case contributed by Isabela Azevedo Nicodemos da Cruz
Diagnosis probable

Presentation

Presenting with a mild headache. No other symptoms.

Patient Data

Age: 65 years
Gender: Female

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

MRI Brain

mri

Mass epicentered upon the fourth ventricle, with a low T1 signal, high T2 signal and dirty slightly hyperintense FLAIR signal (partial suppression). Intense bright signal on DWI sequences and no enhancement after contrast injection. The mass expands the foramen of Magendie and right foramen of Luschka.  

Case Discussion

The typical features of an epidermoid cyst are illustrated in this case: the mass follows the CSF signal both on T1 and on T2 sequences. Dirty FLAIR signal is often seen, and the combination of restricted diffusion and T2 shine-through effect causes a bright DWI signal. The location on the fourth ventricle is not unusual.

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