Ruptured Intracranial Dermoid Cyst

Abstract

Rupture of an intracranial dermoid cyst is a rare event with considerable associated morbidity and potential mortality. We present a case of intracranial rupture of a dermoid cystic tumor with consequent dissemination of subarachnoid fat droplets resulting in acute aseptic chemical meningitis. Radiographic findings, operative treatment, and pathologic features are described.

Ruptured Intracranial Dermoid Cyst: Unusually Rapid Disease Course Leading to a Fatal Outcome

“…Symptoms associated with unruptured cysts are usually due to mass effect and slowly progressive in nature, while rupture results in spillage of fatty globules into the ventricles and/or in subarachnoid space. The irritative effect of these lipid metabolites leads to aseptic granulomatous meningitis, vasospasm with or without cerebral ischemia, and hydrocephalus [1][2][3][4][5]. Rupture of these cysts is often a spontaneous process, but closed head injury has been implicated in certain cases [1-3, 5, 8-10].…”

“…In such cases, fluid attenuation inversion recovery (FLAIR) is useful, in that the fat will appear hyperintense (bright) on a background of suppressed fluid signal (dark). If meningitis is present, meningeal enhancement is evident after administration of gadolinium contrast [2][3][4]11].…”

“…Intracranial dermoid cysts are rare, non-neoplastic, congenital ectodermal inclusion cysts of embryological origin containing various ectodermal derivatives, including apocrine glands, sebaceous glands, hairs, squamous epithelium, and occasionally teeth [1][2][3][4][5]. Epidermoid cysts, in contrast, only have squamous epithelial lining.…”

“…Epidermoid cysts, in contrast, only have squamous epithelial lining. Intracranial dermoid cysts are commonly located in the suprasellar, frontobasal and temporobasal regions [1][2][3][4][5]. Spontaneous rupture of these cysts is uncommon, and so far, fewer than one hundred cases have been reported in the medical literature [1][2][3].…”

“…Spontaneous rupture of these cysts is uncommon, and so far, fewer than one hundred cases have been reported in the medical literature [1][2][3]. Ruptured intracranial dermoid cysts (RICDC) can present with headache (33%), seizures (26%), cerebral ischemia with focal deficit (16%), and aseptic meningitis (8%) [1][2][3][4][5]. It can also lead to death [6][7].…”