Background: A 27-year-old man presented at the emergency room with episodic acute headaches and nausea for a few weeks. Neurological examination was normal

C. E. Firanescu

M. Sluzewski

Journal of the Belgian Society of Radiology

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JBR–BTR, 2015, 98: 121-122.
RUPTURED INTRACRANIAL DERMOID CYST
C.E. Firanescu, M. Sluzewski1
Key-word: Dermoid 
1. Department of Radiology, St. Elisabeth Hospital, LC Tilburg, The Netherlands
Background: A 27-year-old man presented at the emergency room with episodic acute  headaches 
and nausea for a few weeks. Neurological examination was normal. 
1A 1B
Fig.
2A 2B
A B
A B
RupTuRED iNTRACRANiAL DERMoiD CyST — FIRANESCU et al 122
Work-up
Axial non-enhanced CT image of the brain (Fig. 1) 
shows a large tumor in the anterior horn of the right 
lateral ventricle with low attenuation (-128 Hu) and 
calcifications. Additionally, low attenuation lesions 
are depicted in the anterior horn of the left ventri-
cle. on B, similar very small low attenuation lesions 
are scattered in the subarachnoidal space of the 
Sylvian fissure bilaterally and the ambient cistern.
MRi of the brain (Fig. 2) shows on transverse 
FLAiR image (A) mixed intensities in the tumor at 
the right lateral ventricle with a hyperintense “cap”. 
The lesion in the left frontal horn is hyperintense. 
There is a mild hydrocephalus. on transverse 
 gadolinium-enhanced T1-weighted image (B), the 
tumor shows no enhancement. The “cap” in the 
right frontal horn and lesion in the left frontal horn 
are spontaneously hyperintense on native T1-
weighted images (not shown).
Radiological diagnosis
Based on the findings on CT scan and MRi the 
diagnosis of ruptured intracranial dermoid cyst was 
made.
At surgery, the tumor at the right ventricle, 
 containing fat and hair follicles, was removed. Fat 
content was removed from the contralateral ven-
tricle. Histological examination revealed a dermoid 
cyst.
Discussion
intracranial dermoid cyst is a rare, slow growing 
benign lesion accounting for 0.04 to 0.6% of all in-
tracranial tumors, and has an embryological origin. 
Sebaceous glands, hair follicles, and sweat glands 
can be found histologically. Typically, these lesions 
are found in the midline. Rupture of an intracranial 
dermoid is a rare, but well known complication. 
Rupture of content such as fat, into the ventricles 
and/or subarachnoidal space, leads to a so-called 
chemical meningitis that may be complicated by 
hydrocephalus, seizures and even cerebral 
 ischemia. Rupture is mostly spontaneous but can 
follow closed head injury. Clinical symptoms 
 include headache and seizures, and are often indis-
tinguishable from other causes of meningitis and 
subarachnoid hemorrhage.
Dermoid cysts show mixed density on CT, re-
flecting the content of hypodense fat and hyper-
dense calcifications. When ruptured, low-density 
fat droplets spread through the ventricles and the 
subarachnoid space. A fat cerebrospinal fluid (CFS) 
level may be seen, as was the case in our patient. 
on MRi, the fat will be hyperintense on T1-weight-
ed and hypointense on the fat suppression images. 
The calcified parts, hairs, and epithelial debris will 
be hypointense on the T1-weighted images and 
 inhomogeneously hyperintense on T2-weighted 
images. When the cyst ruptures, high-signal 
 droplets on T1 images may be seen scattered 
throughout the cerebrospinal fluid. The FLAiR 
 sequence will show the hyperintense fat floating in 
the ventricles. After administration of gadolinium, 
there will be no enhancement.
Bibliography
1. Grijseels S., Stadnik T., Bouwens L.: CT and MR
findings in ruptured dermoid cyst in the right
parasellar cistern: report of a case. J Belge  Radiol,
1992, 75: 41-43.
2. Lunardi p., Missori p.: Supratentorial dermoid
cysts. J Neurosurg, 1991, 75: 262-266.


Ruptured Intracranial Dermoid Cyst

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Ruptured Intracranial Dermoid Cyst

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