Asymptomatic Intracranial Epidermoid Cyst

A 15-year-old male undergoes brain MRI after a mild traumatic brain injury. Axial T2 (image 1), T1 postcontrast (image 2), and FLAIR (image 3) sequences showed a cystic lesion involving the right superior frontal gyrus with no concerning edema or mass effect. 

The lesion had mild heterogeneous signal on FLAIR and showed restricted diffusion and no contrast enhancement. These features are characteristic of an epidermoid cyst. Epidermoid cysts most commonly occur at the cerebellar pontine angle or the region of the fourth ventricle, but they can also occur supratentorially. They are usually very slow growing. 

FLAIR and DWI sequences are useful for differentiation of these lesions from arachnoid cysts due to their heterogeneous FLAIR signal, higher than cerebrospinal fluid, and abnormal diffusion restriction with T2 shine-through. Surgical excision is the treatment of choice if symptomatic, but no treatment is indicated in an asymptomatic patient.


Further Reading

  1. Figure 1 Medical Case
  2. Intraparenchymal Epidermoid Cyst: Proper Surgical Management may Lead to Satisfactory Outcome
  3. Intrinsic Brainstem Epidermoid Cyst. Case Report and Review of the Literature

Reference

  1. Dutt SN, Mirza S, Chavda SV, Irving RM. Radiologic differentiation of intracranial epidermoids from arachnoid cysts. Otol Neurotol 2002;23(1):84-92.

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