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Intraparenchymal endodermal cyst with spontaneous intracystic hemorrhage in the temporal lobe of an adult

View Article: PubMed Central - PubMed

ABSTRACT

Background:: Endodermal cysts (EC) are rare but well-known congenial lesions of the central nervous system mainly located in the spinal subdural space. Intracranial ECs are rare and commonly encountered in the posterior cranial fossa as extra-axial lesions; an intraparenchymal location is exceedingly rare. A complete removal is the best surgical strategy and any residue can cause recurrence. It is necessary to exclude EC in patients with intracranial cystic lesions. We present a case of intraparenchymal EC with spontaneous intracystic hemorrhage in the temporal lobe of an adult.

Methods:: A 43-year-old man presented with headache and memory deterioration. Brain computed tomography and magnetic resonance imaging showed a slightly enhanced temporal lobe cystic lesion, which was homogenously hyperintense on T1-and T2-weighted images. There was a suspicion of brain abscess at admission. The lesion was totally removed with a left subtemporal craniotomy. Histological examination revealed an EC with intracystic hemorrhage.

Results:: The preoperative symptoms were relieved after surgery and 3-month follow-up magnetic resonance imaging found no cystic signs.

Conclusion:: This case suggests that EC should be considered in the differential diagnosis of intracranial cystic lesions and a complete removal is the best strategy of choice.

No MeSH data available.


Brain CT and MRI at admission. Nonenhanced (A) and enhanced (B) CT; T1-weighted (C) and T2-weighted (D) MRI; axial (E) and coronal (F) enhanced T1-MRI. CT = computed tomography, MRI = magnetic resonance imaging.
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Figure 1: Brain CT and MRI at admission. Nonenhanced (A) and enhanced (B) CT; T1-weighted (C) and T2-weighted (D) MRI; axial (E) and coronal (F) enhanced T1-MRI. CT = computed tomography, MRI = magnetic resonance imaging.

Mentions: A 43-year-old male was admitted to hospital for 3-year headache and memory deterioration. He had a 10-year history of otitis media and no history of head trauma. Neurological examination and hematological test were normal. Brain computed tomography (CT) revealed a cystic lesion in the left temporal lobe (Fig. 1A and B). The cyst wall was hyperdense and slightly enhanced, cyst fluid exhibited low density, and some sediment appeared in the cyst. Magnetic resonance imaging (MRI) showed a hypodense cyst wall, hyperdense cyst fluid, and isointense sediment on T1- and T2-weighted images (Fig. 1C and D). Only the cyst wall showed slight enhancement after gadolinium injection (Fig. 1E and F). There was no observable edema around the cyst on both CT and MRI. The patient was diagnosed as having brain abscess based on otitis media history and imaging.


Intraparenchymal endodermal cyst with spontaneous intracystic hemorrhage in the temporal lobe of an adult
Brain CT and MRI at admission. Nonenhanced (A) and enhanced (B) CT; T1-weighted (C) and T2-weighted (D) MRI; axial (E) and coronal (F) enhanced T1-MRI. CT = computed tomography, MRI = magnetic resonance imaging.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120888&req=5

Figure 1: Brain CT and MRI at admission. Nonenhanced (A) and enhanced (B) CT; T1-weighted (C) and T2-weighted (D) MRI; axial (E) and coronal (F) enhanced T1-MRI. CT = computed tomography, MRI = magnetic resonance imaging.
Mentions: A 43-year-old male was admitted to hospital for 3-year headache and memory deterioration. He had a 10-year history of otitis media and no history of head trauma. Neurological examination and hematological test were normal. Brain computed tomography (CT) revealed a cystic lesion in the left temporal lobe (Fig. 1A and B). The cyst wall was hyperdense and slightly enhanced, cyst fluid exhibited low density, and some sediment appeared in the cyst. Magnetic resonance imaging (MRI) showed a hypodense cyst wall, hyperdense cyst fluid, and isointense sediment on T1- and T2-weighted images (Fig. 1C and D). Only the cyst wall showed slight enhancement after gadolinium injection (Fig. 1E and F). There was no observable edema around the cyst on both CT and MRI. The patient was diagnosed as having brain abscess based on otitis media history and imaging.

View Article: PubMed Central - PubMed

ABSTRACT

Background:: Endodermal cysts (EC) are rare but well-known congenial lesions of the central nervous system mainly located in the spinal subdural space. Intracranial ECs are rare and commonly encountered in the posterior cranial fossa as extra-axial lesions; an intraparenchymal location is exceedingly rare. A complete removal is the best surgical strategy and any residue can cause recurrence. It is necessary to exclude EC in patients with intracranial cystic lesions. We present a case of intraparenchymal EC with spontaneous intracystic hemorrhage in the temporal lobe of an adult.

Methods:: A 43-year-old man presented with headache and memory deterioration. Brain computed tomography and magnetic resonance imaging showed a slightly enhanced temporal lobe cystic lesion, which was homogenously hyperintense on T1-and T2-weighted images. There was a suspicion of brain abscess at admission. The lesion was totally removed with a left subtemporal craniotomy. Histological examination revealed an EC with intracystic hemorrhage.

Results:: The preoperative symptoms were relieved after surgery and 3-month follow-up magnetic resonance imaging found no cystic signs.

Conclusion:: This case suggests that EC should be considered in the differential diagnosis of intracranial cystic lesions and a complete removal is the best strategy of choice.

No MeSH data available.