Traumatic rupture of an intracranial dermoid cyst. Radiol Case Rep. 2015;10:1053. [PMID: 27408663 PMCID: PMC4921191 DOI: 10.2484/rcr.v10i1.1053]

A Case Report of Ruptured Intracranial Dermoid Cyst

Intracranial dermoid cysts, rare congenital lesions originating from ectodermal elements during neural tube closure, are explored in the context of a 45-year-old female presenting with a sudden-onset severe headache, nausea, and vomiting. A thorough neurological examination revealed no focal deficits, prompting a computed tomography scan that identified multiple extra-axial intracranial fat density lesions indicative of dermoid cysts. Laboratory and cerebrospinal fluid analysis confirmed inflammatory changes, characterized by an increased white blood cell count. Successful surgical intervention followed, resulting in the complete removal of the cyst and the patient's subsequent full recovery with the resolution of symptoms. This case highlights the intricate nature of intracranial dermoid cysts and underscores the critical importance of prompt recognition in effectively mitigating potential complications.

Traumatic rupture of intracranial dermoid cyst with continuous fat droplet migration

Background

The intracranial dermoid cyst (ICD) can be complicated by rupture and spilling of its contents with potentially dreadful consequences. Head trauma as a predisposing element for this phenomenon is extremely rare. Few reports address the diagnosis and management of trauma-related rupture of ICD. However, there is a pronounced knowledge gap related to the long-term follow-up and the fate of the leaking contents. Here, we present a unique case of traumatic rupture of ICD complicated by continuous fat particle migration within the subarachnoid space with its surgical implications and outcome.

Case Description

A 14-year-old girl had an ICD rupture following a vehicle collision. The cyst was located near the foramen ovale with intra and extradural extensions. Initially, we opted to follow the patient clinically and radiologically as she had no symptoms, and the imaging showed no red flags. Over the next 24 months, the patient remained asymptomatic. However, the sequential brain magnetic resonance imaging revealed significant continuous migration of the fat within the subarachnoid space, with the droplets noticed to increase in the third ventricle. That is considered an alarming sign of potentially serious complications impacting the patient's outcome. Based on the above, the ICD was completely resected through an uncomplicated microsurgical procedure. On follow-up, the patient is well, with no new radiological findings.

Conclusion

Trauma-related ruptured ICD may have critical consequences. Persistent migration of dermoid fat can be managed with surgical evacuation as a viable option to prevent those potential complications such as obstructive hydrocephalus, seizures, and meningitis.

Traumatic Rupture of a Skull Base Dermoid Cyst Mimicking Chronic Meningitis

Cranial dermoid cysts are rare, embryologic tumors containing fat, hair, and other ectodermal elements. They occur most frequently in the posterior fossa and are typically diagnosed as incidental findings on brain imaging done for an unrelated reason. Traumatic rupture of a previously unidentified intracranial dermoid cyst can mimic symptoms of post-concussion syndrome and should be ruled out with magnetic resonance imaging (MRI). Surgical intervention after traumatic rupture may not result in complete symptom control due to the persistence of dermoid cyst debris in the subarachnoid space. Here, we present the clinical scenario and radiological features of a ruptured dermoid cyst due to trauma, highlighting a rare complication of a classically benign lesion.

Asymptomatic traumatic rupture of an intracranial dermoid cyst: A case report

BACKGROUND

Previous studies reported that most of the intracranial dermoid cyst ruptures were spontaneous, and only a few were traumatic, with asymptomatic much rarer than the symptomatic ruptures. Hence, how to deal with the asymptomatic traumatic rupture of intracranial dermoid cyst remains a challenge in the clinic.

CASE SUMMARY

A 59-year-old man was accidentally diagnosed with intracranial dermoid cyst through a cranial computed tomography (CT) scan due to a car accident. A mixed-density lesion with fat and a calcified margin was observed in the midline of the posterior fossa, accompanied with lipid droplet drifts in brain sulci, fissures, cisterns, and ventricles. After 1 wk of conservative observation, no change was observed on the updated cranial CT scan. After 2 wk of conservative observation, magnetic resonance imaging examination confirmed that the lesion was a traumatic rupture of a posterior fossa dermoid cyst with lipid droplet drifts. As the patient exhibited no adverse symptoms throughout the 2 wk, a 6-mo follow-up visit was arranged for him instead of aggressive treatment. Nonetheless, the patient did not show any abnormal neurological symptoms in the 6 mo of follow-up visits.

CONCLUSION

Asymptomatic traumatic rupture of intracranial dermoid cyst could be just followed or treated conservatively rather than treated aggressively.

Chemical Meningitis after a Golf Swing-induced Dermoid Cyst Rupture

A 51-year-old man developed a sudden headache during golf practice, followed by a high fever. He was admitted with suspected neutrophilic meningitis and was diagnosed with chemical meningitis caused by a dermoid cyst rupture based on the characteristic magnetic resonance imaging (MRI) findings, which showed multiple lipid droplets in his ventricle and cistern. His repetitive golf-swing motion was suggested to be the cause of his dermoid cyst rupture. On MRI, the lipid droplets appeared to have migrated by gravity because of the body position. Therefore, the body position should be considered to prevent obstructive hydrocephalus by lipid droplets after a dermoid cyst rupture.

Focal traumatic rupture of a dermoid cyst in a pediatric patient: case report and literature review

BACKGROUND

Dermoid cysts are rare congenital teratomas that can occasionally rupture and cause chemical meningitis, neurological deficit, or hydrocephalus. Rarely, dermoid cysts in the pediatric population can rupture spontaneously and even more rarely rupture due to trauma. To date, there are only five documented cases of traumatic rupture of a dermoid cyst. A 2-year-old male presented with 5 days of left eye ptosis and ophthalmoplegia after suffering a fall and was found to have a ruptured left anterior clinoid dermoid cyst that was surgically resected. The patient had significant improvement postoperatively.

SIGNIFICANCE

To the authors' knowledge, this is the first reported case in the literature of a ruptured dermoid cyst after trauma in a pediatric patient and the first case of a traumatically ruptured dermoid cyst presenting with neurological deficit.

Acute Urinary Retention Induced by Chemical Meningitis Which Occurred Due to a Ruptured Dermoid Cyst

Meningitis retention syndrome (MRS), a rare complication of aseptic meningitis, can present with acute urinary retention. The rupture of a dermoid cyst, which is a benign intracranial tumor, can sometimes induce chemical meningitis. We herein present a case of chemical meningitis and acute urinary retention that was induced by the rupture of a dermoid cyst. The patient experienced urinary retention for approximately 60 days, and then made a complete recovery thereafter. This is the first reported case of acute urinary retention due to the rupture of a dermoid cyst.