Age: 69
Sex: Female
Indication: Headache
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Case #39
Findings
- Multiple foci of T1 signal hyperintensity within the subarachnoid spaces including the nondependent aspect of the frontal horn of the left lateral ventricle, the inferior aspect of the fourth ventricle, the suprasellar cistern, and the left ambient cistern
- Associated hypointense signal on the fat-saturated T2 sequence
- Generalized cerebral and cerebellar volume loss with ex vacuo enlargement of the ventricular system
- Patchy T2/FLAIR hyperintensities in the subcortical and periventricular white matter
- Small areas of encephalomalacia in the anterior right temporal lobe and inferior right frontal lobe
- No evidence of acute infarct, hemorrhage, mass effect, or hydrocephalus
- Extensive mucosal thickening of the right sphenoid sinus
- Right pseudophakia
Diagnosis
- Ruptured dermoid cyst
Sample Report
Multiple foci of fat signal layering nondependently in the left lateral ventricle, in the inferior aspect of the fourth ventricle, and in the extraventricular CSF spaces concerning for ruptured dermoid cyst. The location of the original dermoid cyst is not clearly identified and could be associated with one of the larger sites of fat accumulation or could instead be located in the spine. Consider noncontrast total spine MRI for further evaluation.
Background of chronic small vessel disease and generalized cerebral and cerebellar volume loss with ex vacuo enlargement of the ventricular system.
Small areas of encephalomalacia in the anterior right temporal lobe and inferior right frontal lobe likely represent sequela of remote trauma.
No evidence of acute infarct, hemorrhage, mass effect, or hydrocephalus.
Extensive mucosal thickening of the right sphenoid sinus, which can be seen with sinusitis.
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