Presentation
Chronic headaches.
Patient Data
Well-defined ovoid extra-axial midline mass, anterior to the pontomedullary junction extending to the left lower cerebellopontine angle, with moderate elevation and displacement of the pons and medulla. It appears isointense on T1WI with areas of low signal and heterogeneous high signal on FLAIR and T2WI. No enhancement seen on postcontrast sequences. No restricted diffusion is seen on DWI/ADC.
The clivus shows a normal appearance.
No associated midline clefting is seen.
Case Discussion
MRI features suggestive of an intracranial neurenteric cyst.
The intracranial location of the neurenteric cysts is much less common than the spinal location. 80% of cases are located in the posterior fossa anterior to the pontomedullary junction, and 20% in the supratentorial region adjacent to the frontal lobes. Associated vertebral anomalies are seen in approximately 50% of spinal neurenteric cysts, while are rarely seen in intracranial location 1 (as in this case).
Imaging differential considerations include:
-
arachnoid cyst
- has CSF signal on all sequences
-
epidermoid cyst
- similar to CSF in signal
- restricted diffusion
- cystic schwannoma
- usually presence of a solid enhancing component
-
intracranial lipoma
- high signal on all sequences (fat signal)
- attenuated on fat-suppressed sequences
-
ecchordosis physaliphora
- a stalk-like connection to the clivus
- variable enhancement
-
chordoma
- usually enhances with contrast
Additional contributor: Farid Kessaci, MD CHU Bab El-Oued, Algiers Algeria
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