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20 y.o. male with a headache.

Findings:

CT: Multifocal hypodensities within the ventricles and subarachnoid space.

MRI: T1 & PD reveals multifocal hyperintense droplets within the subarachnoid space and ventricular system. Chemical shift artifact depicted.

DDx:

Lipoma

Teratoma

Dermoid

Pantopaque

Ruptured Dermoid

Not a true neoplasm, but rather a lesion of ectodermal origin. Result of embryonic ectodermal inclusion into the neural tube (5th – 6th weeks).

Contains skin appendages such as hair follicles and sebaceous cysts.

Slow growing. Benign.

Dermoids…midline.

Epidermoids…off midline.

M > F

Ruptured Dermoid

Dermoids are usually found in younger patients than epidermoids.

Usually present in the 3rd decade of life with a long history of vague symptoms.

Headache, sz, focal neuro. deficits, and aseptic meningitis.

Lesions grow secondary to glandular secretions and epithelial desquamation.

Ruptured Dermoid

Rupture can occur spontaneously.

Chemical meningitis can lead to vasospasm, infarction, and death.

Fat sat. techniques are often helpful.

Lipids can be found in the CSF when ruptured.

Ruptured Dermoid

Shouldn’t cause vasogenic edema.

Rarely enhance.

Rarely cause hydrocephalus.

Capsular Ca++ is frequent.