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Intraosseous cerebrospinal fluid (CSF) cysts, also known as intra-diploic arachnoid cysts, are usually of post-traumatic origin. Lesions presenting without a history of trauma are rare and are presumed to be of congenital origin. We report a young man with an intraosseous cystic lesion containing CSF and communicating with the intracranial subarachnoid space through a dural opening. The presence of other congenital defects of the skull and spine could be a pointer in this direction. Surgical management involves craniectomy and repair of the dural defect followed by cranioplasty for the bony defect.

Lesson Case presentationA 67-year-old Caucasian woman presented to the emergency department with a 3-day history of rapidly worsening dyspnoea on the background of a 3-month history of lethargy and exertional dyspnoea. Her medical history was significant for hypercholesterolaemia and diet-controlled type 2 diabetes mellitus. She was a current smoker. A myocardial perfusion scan performed 6 weeks before the current presentation had been unremarkable.

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