A 44-year-old man presented following a tonicclonic seizure. Intracranial epidermoid cysts
account for approximately 1% of primary intracranial tumours. They are benign slow growing
tumours derived from ectodermal inclusions during neural tube closure.peer-reviewe

Grech, Reuben

Schembri, Mark

English

PubMed

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Interhemispheric epidermoid cystMark Schembri,1 Reuben Grech21Mater Dei Hospital, Msida,Malta2Department ofNeuroradiology, BeaumontHospital, Dublin, IrelandCorrespondence toDr Mark Schembri,schem097@gmail.comAccepted 9 November 2015To cite: Schembri M,Grech R. BMJ Case RepPublished online: [pleaseinclude Day Month Year]doi:10.1136/bcr-2015-213393DESCRIPTIONA 44-year-old man presented following a tonic-clonic seizure. Intracranial epidermoid cystsaccount for approximately 1% of primary intracra-nial tumours. They are benign slow growingtumours derived from ectodermal inclusions duringneural tube closure. Typical presentation is betweenthe ages of 20 and 40 years.Epidermoid cysts are frequently found in thecerebellopontine angle, being the third commonestlesion at this site, following vestibularschwannomas and meningiomas. Lesions arising inthe interhemispheric fissure are rare, accountingfor approximately 4% of all intracranial locations.1Clinical presentation is related to gradual masseffect and depends largely on the location of thetumour, the commonest symptoms being hearingloss, trigeminal neuralgia and headaches. Incidenceof seizures is higher in patients with supratentoriallesions.2On CT, epidermoids appear as lobulated hypoat-tenuating lesions that exert gradual mass effect(figure 1). MRI is the imaging modality of choicewith the lesion often indistinguishable fromarachnoid cysts on many sequences (figure 1). Thecharacteristic heterogeneous/dirty signal on fluid-attenuated inversion recovery and restricteddiffusion, owing to a combination of true restricteddiffusion and T2 shine-through, aid in differentiat-ing epidermoid cysts from arachnoid cysts(figure 2). Most epidermoid cysts do not enhance,although minimal rim enhancement occurs inapproximately 25% of cases.3Surgical excision remains the mainstay of treat-ment, often with incomplete resection due toadherence of the capsule to important neurovascu-lar structures. At surgery, the tumour has anirregular cauliflower outer surface and is composedof a pearly material lending the name ‘beautifultumour’.Learning points▸ The interhemispheric fissure is a rare butrecognised site of intracranial epidermoidcysts.▸ Intracranial epidermoid cysts demonstratecharacteristic MR findings on diffusion-weightedimaging and fluid-attenuated inversion recoverysequences, allowing for accurate diagnosis in anatypical location.Contributors MS performed the literature review and drafted thewrite up. RG was responsible for the images provided, review andfinal approval of the submitted article.Figure 1 Axial unenhanced CT image (A) showing a lobulated hypoattenuating lesion in the interhemisphericregion. Coronal T1-weighted image (T1WI) postcontrast (B) showing a non-enhancing hypointense lesion in theinterhemispheric fissure and sagittal T2WI (C) showing a hyperintense signal within the lesion.Figure 2 Axial fluid-attenuated inversion recoveryimage (A) demonstrating a characteristic heterogeneous/dirty signal and diffusion-weighted image (B) showingrestricted diffusion.Schembri M, Grech R. BMJ Case Rep 2015. doi:10.1136/bcr-2015-213393 1Images in…by copyright. on 19 May 2020 at Periodicals Dept. Library. Protectedhttp://casereports.bmj.com/BMJ Case Reports: first published as 10.1136/bcr-2015-213393 on 24 November 2015. Downloaded from Competing interests None declared.Patient consent Obtained.Provenance and peer review Not commissioned; externally peer reviewed.REFERENCES1 Agarwal V, Vijayan A, Velho V, et al. Pearl in interhemispheric fissure: a rarephenomenon. Asian J Neurosurg 2012;7:229.2 Chowdhury FH, Haque MR, Sarker MH. Intracranial epidermoid tumor;microneurosurgical management: an experience of 23 cases. Asian J Neurosurg2013;8:21–8.3 Osborn AG, Preece MT. Intracranial cysts: radiologic-pathologic correlation andimaging approach. Radiology 2006;239:650–64.Copyright 2015 BMJ Publishing Group. All rights reserved. For permission to reuse any of this content visithttp://group.bmj.com/group/rights-licensing/permissions.BMJ Case Report Fellows may re-use this article for personal use and teaching without any further permission.Become a Fellow of BMJ Case Reports today and you can:▸ Submit as many cases as you like▸ Enjoy fast sympathetic peer review and rapid publication of accepted articles▸ Access all the published articles▸ Re-use any of the published material for personal use and teaching without further permissionFor information on Institutional Fellowships contact consortiasales@bmjgroup.comVisit casereports.bmj.com for more articles like this and to become a Fellow2 Schembri M, Grech R. BMJ Case Rep 2015. doi:10.1136/bcr-2015-213393Images in…by copyright. on 19 May 2020 at Periodicals Dept. Library. Protectedhttp://casereports.bmj.com/BMJ Case Reports: first published as 10.1136/bcr-2015-213393 on 24 November 2015. Downloaded from 

Interhemispheric epidermoid cyst

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Interhemispheric epidermoid cyst

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