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Baraya N, Van Stavern GP, Stunkel L. Pearls & Oy-sters: Case Report of a Ruptured Suprasellar Dermoid Cyst Presenting With Junctional Scotoma of Traquair. Neurology 2024; 103:e209559. [PMID: 39018519 DOI: 10.1212/wnl.0000000000209559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024] Open
Abstract
A 27-year-old woman with a known suprasellar dermoid cyst and stable idiopathic intracranial hypertension (IIH) presented with new monocular vision change and new-onset headaches. Formal visual field testing accurately identified progressive chiasmal compression due to her suprasellar dermoid cyst before radiographic change was appreciable on magnetic resonance imaging. Accurate interpretation of her visual field findings avoided the common pitfall of attributing new visual symptoms to her IIH diagnosis. This case highlights the value of recognizing visual field changes that localize to the chiasm even in patients with history of other ophthalmologic conditions.
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Affiliation(s)
- Naman Baraya
- From John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences (G.P.V.S., L.S.), and Department of Neurology (G.P.V.S., L.S.), Washington University School of Medicine (N.B.), St. Louis, MO
| | - Gregory P Van Stavern
- From John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences (G.P.V.S., L.S.), and Department of Neurology (G.P.V.S., L.S.), Washington University School of Medicine (N.B.), St. Louis, MO
| | - Leanne Stunkel
- From John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences (G.P.V.S., L.S.), and Department of Neurology (G.P.V.S., L.S.), Washington University School of Medicine (N.B.), St. Louis, MO
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2
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Berrada K, Bougrin I, Ouali IE, Fikri M, Jiddane M, Touarsa F. Acute headache and seizures in psychiatric patient revealing atypical location of a ruptured dermoid cyst. Radiol Case Rep 2024; 19:1040-1045. [PMID: 38226054 PMCID: PMC10788375 DOI: 10.1016/j.radcr.2023.11.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 01/17/2024] Open
Abstract
Intracranial dermoid cysts are rare slow-growing cystic lesions. They are frequently extra-axial, intra-axial localization is very rare. These benign congenital ectodermal inclusions cysts have a rare risk of rupture. Ruptured dermoid cysts can manifest with headache, epilepsy seizure, cerebral infarction, meningitis, and hydrocephaly. Neuroimaging features are quite characteristic. We report a case of a 30-year-old male who presented to the emergency room with subacute-onset headaches. CT scan and MRI show a ruptured intracranial dermoid cyst.
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Affiliation(s)
- Kenza Berrada
- Department of Neuroradiology, Specialties Hospital, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Imad Bougrin
- Department of Neuroradiology, Specialties Hospital, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Ibtissam El Ouali
- Department of Neuroradiology, Specialties Hospital, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Meryem Fikri
- Department of Neuroradiology, Specialties Hospital, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Mohamed Jiddane
- Department of Neuroradiology, Specialties Hospital, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Firdaous Touarsa
- Department of Neuroradiology, Specialties Hospital, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
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3
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Aktham A, Morita S, Takeuchi S, Ismail M, Hoz SS, Numazawa S, Watanabe S, Mori K. Traumatic rupture of intracranial dermoid cyst with continuous fat droplet migration. Surg Neurol Int 2023; 14:39. [PMID: 36895256 PMCID: PMC9990783 DOI: 10.25259/sni_801_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Awfa Aktham
- Department of Neurosurgery, Tokyo General Hospital, Tokyo, Japan
| | - Shuhei Morita
- Department of Neurosurgery, Tokyo General Hospital, Tokyo, Japan
| | - Satoru Takeuchi
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Japan
| | - Mustafa Ismail
- Department Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Samer S Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, United States
| | | | | | - Kentaro Mori
- Department of Neurosurgery, Tokyo General Hospital, Tokyo, Japan
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4
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Taha A, Abdelrazek MA, Manalo N, Elsadek R, Morrin SJ, Brodski A, Augustynowiczd A, Mollashahi RS, Shenoy A. Traumatic Rupture of a Skull Base Dermoid Cyst Mimicking Chronic Meningitis. Cureus 2022; 14:e25066. [PMID: 35719751 PMCID: PMC9203259 DOI: 10.7759/cureus.25066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/06/2022] Open
Abstract
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.
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5
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Alsallamin I, Choudhury R, Somoza-cano FJ, Makadia A, Mudrieddy M, Weiland A, Bawwab A, Alsallamin A, Hammad F, Patell K, Al Armashi AR. An Unusual Presentation of Spontaneous Rupture of Dermoid Cyst. Cureus 2022; 14:e21976. [PMID: 35282536 PMCID: PMC8906196 DOI: 10.7759/cureus.21976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Abstract
Intracranial dermoid cysts are exceptionally rare tumors. Interestingly, this condition has a low mortality rate but a high morbidity rate due to its numerous complications. We report a case of a 62-year-old man who presented with a headache and was found to have a ruptured dermoid cyst, complicated with the dissemination of lipid droplets within the subarachnoid space.
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6
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Wilson RP. Asymptomatic rupture of an intracranial dermoid cyst: to intervene or not to intervene? BMJ Case Rep 2022; 15:e247105. [PMID: 35039371 PMCID: PMC8768869 DOI: 10.1136/bcr-2021-247105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/04/2022] Open
Abstract
Dermoid cysts are an exceedingly rare phenomenon inside the cranial vault. These benign, slow-growing lesions can rupture, releasing cyst contents into the ventricular system and subarachnoid space causing pathology in the form of chemical meningitis and vasospasm. Here, we present the case of a 26-year-old man who was investigated for a facial nerve palsy and was incidentally found to have a ruptured dermoid cyst in the pineal region, with dissemination of cyst contents throughout the ventricular system.
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Affiliation(s)
- Robert Peter Wilson
- Department of Haematology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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7
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Perdomo-Pantoja A, Zakaria HM, Judy BF, Khalifeh JM, Porras JL, Azad TD, Hwang BY, Witham TF, Bettegowda C, Theodore N. Traumatic sacral dermoid cyst rupture with intracranial subarachnoid seeding of lipid particles: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 2:CASE21355. [PMID: 35855487 PMCID: PMC9281439 DOI: 10.3171/case21355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/19/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Intracranial deposits of fat droplets are an unusual presentation of a spinal dermoid cyst after spontaneous rupture and are even more uncommon after trauma. Here, the authors present a case with this rare clinical presentation, along with a systematic review of the literature to guide decision making in these patients. OBSERVATIONS A 54-year-old woman with Lynch syndrome presented with severe headache and sacrococcygeal pain after a traumatic fall. Computed tomography of the head revealed multifocal intraventricular and intracisternal fat deposits, which were confirmed by magnetic resonance imaging (MRI) of the neuroaxis; in addition, a ruptured multiloculated cyst was identified within the sacral canal with proteinaceous/hemorrhagic debris, most consistent with a sacral dermoid cyst with rupture into the cerebrospinal fluid (CSF) space. An unruptured sacral cyst was later noted on numerous previous MRI scans. In our systematic review, we identified 20 similar cases, most of which favored surgical treatment. LESSONS Rupture of an intraspinal dermoid cyst must be considered when intracranial fat deposits are found in the context of cauda equina syndrome, meningism, or hydrocephalus. Complete tumor removal with close postoperative follow-up is recommended to decrease the risk of complications. CSF diversion must be prioritized if life-threatening hydrocephalus is present.
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Affiliation(s)
| | - Hesham Mostafa Zakaria
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brendan F Judy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jawad M Khalifeh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jose L Porras
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tej D Azad
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian Y Hwang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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8
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Bereźniak M, Palczewski P, Czerwiński J, Deręgowska-Cylke M, Gołębiowski M. Intracranial Transthecal Fat Migration After a Sacral Fracture: 2 Case Reports. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932760. [PMID: 34637425 PMCID: PMC8522689 DOI: 10.12659/ajcr.932760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The presence of fat droplets within the subarachnoid space is an uncommon finding, which is almost exclusively associated with a ruptured dermoid cyst. In a trauma setting, transthecal migration of fat droplets is an extremely rare occurrence. We present 2 case reports of intracranial transthecal migration of fatty bone marrow after sacral fractures. CASE REPORT Both patients presented to the Emergency Department (ED) after falls from a standing height. The first patient, an 84-year-old woman, suffered a stable sacral fracture extending into a large meningeal cyst within the right S2 foramen. Her initial neurological assessment and computed tomography (CT) of the head were unremarkable. As the fracture did not require surgical treatment, she was discharged home and prescribed bed rest, analgesics, and venous thromboembolism prophylaxis. Three days after the injury, she was readmitted to the ED with a mild headache, dizziness, and an episode of nausea and vomiting. A follow-up head CT revealed fat droplets in the subarachnoid space and lateral ventricles. After successful symptomatic treatment, she was discharged home in good general condition. The second patient, a 60-year-old man, underwent a head CT for a scalp hematoma, which revealed fat droplets in the 3rd ventricle and right lateral ventricle. The pelvic CT revealed a large sacral meningeal cyst with microfractures in its wall. He was discharged home on the same day and prescribed bed rest and analgesics. CONCLUSIONS The detection of intracranial intrathecal fat droplets in association with a specific trauma mechanism should initiate the search for a sacral fracture.
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Affiliation(s)
- Marlena Bereźniak
- 1st Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Palczewski
- 1st Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Jarosław Czerwiński
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Marek Gołębiowski
- 1st Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
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9
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Sim SY, Choi CY. Rupture of intracranial dermoid cyst by strenuous physical activity due to emotional stress: A case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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10
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Blitz SE, Bernstock JD, Dmytriw AA, Ditoro DF, Kappel AD, Gormley WB, Peruzzi P. Ruptured Suprasellar Dermoid Cyst Treated With Lumbar Drain to Prevent Postoperative Hydrocephalus: Case Report and Focused Review of Literature. Front Surg 2021; 8:714771. [PMID: 34458316 PMCID: PMC8385128 DOI: 10.3389/fsurg.2021.714771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Ruptured intracranial dermoid cysts are extremely rare. Standard treatment consists of endonasal decompression or craniotomy with evacuation and copious irrigation of subarachnoid spaces to remove any disseminated cystic contents. Disseminated fat particles in the subarachnoid space may be the cause of further sequalae, including the subsequent development of chemical meningitis and hydrocephalus. Here, we present a case of ruptured suprasellar dermoid cyst treated with craniotomy for emergent optic nerve decompression, followed by postoperative hydrocephalus successfully treated with lumbar drain. Case description: We describe a 30-year-old man with a history of migraines who presented with acute onset of headache, photophobia, nausea, vomiting, and vision loss in the left eye. Head CT and brain MRI demonstrated a ruptured suprasellar dermoid cyst with associated mass effect on the optic nerves and frontal lobes as well as fat attenuation material within the subarachnoid spaces. The patient underwent left frontotemporal craniotomy for cyst resection and developed non-obstructive hydrocephalus on postoperative day 1, refractory to external ventricular drainage. Placement of a lumbar drain cleared the subarachnoid space of debris derived from the ruptured dermoid cyst, and the hydrocephalus resolved. The patient did not require permanent CSF diversion. Conclusions: Intracranial dermoid cysts are uncommon, and rupture is a rare event. Standard surgical treatment with craniotomy for evacuation may leave disseminated dermoid contents and fat particles throughout the subarachnoid spaces. We highlight a case of ruptured suprasellar dermoid cyst with postoperative communicating hydrocephalus treated with lumbar drain when external ventricular drain (EVD) was ineffective. Review of the current literature reveals inconsistent findings on the effects of remaining fat particles. In cases with clinical evidence of increased intracranial pressure due to non-obstructive hydrocephalus attributable to chemical meningitis, temporary lumbar drainage is an option to be considered before committing the patient to permanent shunting.
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Affiliation(s)
| | - Joshua D Bernstock
- Harvard Medical School, Boston, MA, United States.,Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, MA, United States
| | - Adam A Dmytriw
- Harvard Medical School, Boston, MA, United States.,Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, MA, United States
| | - Daniel Francis Ditoro
- Harvard Medical School, Boston, MA, United States.,Department of Pathology, Brigham and Women's Hospital, Harvard University, Boston, MA, United States
| | - Ari D Kappel
- Harvard Medical School, Boston, MA, United States.,Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, MA, United States
| | - William B Gormley
- Harvard Medical School, Boston, MA, United States.,Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, MA, United States
| | - Pierpaolo Peruzzi
- Harvard Medical School, Boston, MA, United States.,Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, MA, United States
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11
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Zhang MH, Feng Q, Zhu HL, Lu H, Ding ZX, Feng B. Asymptomatic traumatic rupture of an intracranial dermoid cyst: A case report. World J Clin Cases 2021; 9:4046-4051. [PMID: 34141765 PMCID: PMC8180201 DOI: 10.12998/wjcc.v9.i16.4046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/24/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Mei-Hua Zhang
- Department of Radiology, Hangzhou Ninth People's Hospital, Hangzhou 310006, Zhejiang Province, China
| | - Qi Feng
- Department of Radiology, The Affiliation Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Han-Lin Zhu
- Department of Radiology, Hangzhou Ninth People's Hospital, Hangzhou 310006, Zhejiang Province, China
| | - Heng Lu
- Department of Radiology, Hangzhou Ninth People's Hospital, Hangzhou 310006, Zhejiang Province, China
| | - Zhong-Xiang Ding
- Department of Radiology, The Affiliation Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Bo Feng
- Department of Radiology, Hangzhou Ninth People's Hospital, Hangzhou 310006, Zhejiang Province, China
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12
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Tolebeyan AS, Kuruvilla DE. Headache in Ruptured Intracranial Dermoid Cysts. Curr Pain Headache Rep 2020; 24:31. [PMID: 32472229 DOI: 10.1007/s11916-020-00863-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW Intracranial dermoid cysts are benign, rare mass-occupying lesions of the central nervous system arising from the neuroectodermal cell lines. While rupture of intracranial dermoid cysts is rare, it can present with a variety of clinical manifestations. To explore the headache manifestations among patients with ruptured intracranial dermoid cysts. To our knowledge, limited studies focusing on headache due to the intracranial dermoid cysts rupture have been published to date. A literature review was done through PubMed/Medline. Articles within the past 10 years were reviewed. Articles in languages other than English were excluded. RECENT FINDINGS Rupture of intracranial dermoid cysts could have various manifestations including headache, seizure, and meningitis. Depending on the location of the cyst, headache secondary to the rupture of the intracranial dermoid cysts could present in different ways. A detailed systematic literature review of headache presentations due to intracranial dermoid cysts rupture is provided.
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13
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Obled L, Peciu-Florianu I, Perbet R, Vannod-Michel Q, Reyns N. Rare Case of Giant Supratentorial Dermoid Cyst. World Neurosurg 2019; 135:72-75. [PMID: 31821914 DOI: 10.1016/j.wneu.2019.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dermoid cysts are benign, congenital rare lesions, frequently occurring in or near the midline. Rare localizations and variable radiologic findings have been described but remain exceptional. CASE DESCRIPTION The authors present a rare case of a giant temporoparietal dermoid cyst in an adult female who was paucisymptomatic. No sign of rupture was identified, with a clinical presentation suggesting a slow-growing lesion. Gross total excision was performed with a favorable clinical and radiologic outcome. CONCLUSIONS Rare localizations previously published in the literature are discussed for dermoid cysts. To our best knowledge, this is the first giant dermoid cyst presenting with this localization.
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Affiliation(s)
- Louis Obled
- Service of Neurosurgery, Department of Neurosciences, CHU Lille, France
| | | | - Romain Perbet
- Service of Pathologic Anatomy, Pathology Institute, CHU Lille, France
| | | | - Nicolas Reyns
- Service of Neurosurgery, Department of Neurosciences, CHU Lille, France
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14
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Shashidhar A, Sadashiva N, Prabhuraj A, Narasingha Rao K, Tiwari S, Saini J, Shukla D, Devi BI. Ruptured intracranial dermoid cysts: A retrospective institutional review. J Clin Neurosci 2019; 67:172-177. [DOI: 10.1016/j.jocn.2019.04.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/28/2019] [Indexed: 12/20/2022]
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15
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Akbari SHA, Somasundaram A, Ferguson CJ, Roland JL, Smyth MD, Strahle JM. Focal traumatic rupture of a dermoid cyst in a pediatric patient: case report and literature review. Childs Nerv Syst 2018; 34:2485-2490. [PMID: 29961083 DOI: 10.1007/s00381-018-3879-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/22/2018] [Indexed: 01/22/2023]
Abstract
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.
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Affiliation(s)
- Syed Hassan A Akbari
- Department of Neurological Surgery, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, 1 Children's Place, St. Louis, MO, 63110, USA.
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, St. Louis, MO, 63110, USA.
| | - Aravind Somasundaram
- Department of Neurological Surgery, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, 1 Children's Place, St. Louis, MO, 63110, USA
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, St. Louis, MO, 63110, USA
| | - Cole J Ferguson
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, St. Louis, MO, 63110, USA
| | - Jarod L Roland
- Department of Neurological Surgery, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, 1 Children's Place, St. Louis, MO, 63110, USA
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, St. Louis, MO, 63110, USA
| | - Matthew D Smyth
- Department of Neurological Surgery, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, 1 Children's Place, St. Louis, MO, 63110, USA
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, St. Louis, MO, 63110, USA
| | - Jennifer M Strahle
- Department of Neurological Surgery, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, 1 Children's Place, St. Louis, MO, 63110, USA
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, St. Louis, MO, 63110, USA
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16
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Jacków J, Tse G, Martin A, Sąsiadek M, Romanowski C. Ruptured intracranial dermoid cysts: a pictorial review. Pol J Radiol 2018; 83:e465-e470. [PMID: 30655926 PMCID: PMC6334092 DOI: 10.5114/pjr.2018.80206] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 08/13/2018] [Indexed: 12/05/2022] Open
Abstract
Intracranial dermoid cysts are rare, benign, congenital, slow-growing cystic lesions. They are composed of mature squamous epithelium and can contain apocrine, eccrine, and sebaceous glands as well as other exodermal structures. Rupture of intracranial dermoid cysts is a relatively uncommon phenomenon but can cause more serious complications such as chemical meningitis, vasospasm, and cerebral infarction. Understanding of the appearance of both unruptured and ruptured dermoid cysts on computed tomography and MRI, especially awareness of existing low signal "blooming artefacts" on certain sequences, aids diagnosis and referral to the proper specialty for appropriate treatment.
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Affiliation(s)
- Jagoda Jacków
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland
| | - George Tse
- Sheffield Teaching Hospital NHS Foundation Trust, Radiology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Andrew Martin
- Sheffield Teaching Hospital NHS Foundation Trust, Radiology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Marek Sąsiadek
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland
| | - Charles Romanowski
- Sheffield Teaching Hospital NHS Foundation Trust, Radiology, Royal Hallamshire Hospital, Sheffield, United Kingdom
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17
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Yamagami K, Kakuta N, Seki K, Nakamura R, Hanioka Y, Nakamura T, Goto H. Acute Urinary Retention Induced by Chemical Meningitis Which Occurred Due to a Ruptured Dermoid Cyst. Intern Med 2018; 57:729-731. [PMID: 29151533 PMCID: PMC5874349 DOI: 10.2169/internalmedicine.9486-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Keiko Yamagami
- Department of Internal Medicine, Osaka City General Hospital, Japan
| | - Naoko Kakuta
- Department of Internal Medicine, Osaka City General Hospital, Japan
| | - Kaori Seki
- Department of Internal Medicine, Osaka City General Hospital, Japan
| | - Ryota Nakamura
- Department of Internal Medicine, Osaka City General Hospital, Japan
| | - Yusuke Hanioka
- Department of Internal Medicine, Osaka City General Hospital, Japan
| | | | - Hitoshi Goto
- Department of Internal Medicine, Osaka City General Hospital, Japan
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18
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Kosuge Y, Onodera H, Sase T, Uchida M, Takasuna H, Ito H, Oshio K, Tanaka Y. Ruptured dermoid cyst of the lateral cavernous sinus wall with temporary symptoms: a case report. J Med Case Rep 2016; 10:224. [PMID: 27520694 PMCID: PMC4983001 DOI: 10.1186/s13256-016-1007-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 07/12/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Dermoid cysts are non-neoplastic tumors that arise from defects in the separation of the neuroectoderm. Cyst rupture rarely occurs spontaneously and the most common symptom is headache, followed by seizure. Although many cases of ruptured dermoid cysts present with symptoms, reports of cases that are asymptomatic, or where symptoms disappear, are rare. CASE PRESENTATION We report the case of a 66-year-old Asian man with a history of sudden onset headache who was found to have high amounts of fat material in the subarachnoid space and a fat suppression mass in the left cavernous sinus. He underwent oral steroid therapy. Five days after starting medication his headache symptoms disappeared. Routine neurological imaging was then performed without surgical procedure. Magnetic resonance imaging revealed evidence of the remains of a static lesion 6 months after his first visit. He has remained headache free for 10 months since the initial event. CONCLUSIONS Although cases of ruptured dermoid cysts presenting with consistent symptoms have been commonly reported, until now there were few reports on asymptomatic cases or cases where symptoms disappeared. We believe that surgical intervention is unnecessary for ruptured dermoid cysts with minimal symptoms.
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Affiliation(s)
- Yasushi Kosuge
- Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Japan.
| | - Hidetaka Onodera
- Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Japan
| | - Taigen Sase
- Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Japan
| | - Masashi Uchida
- Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Japan
| | - Hiroshi Takasuna
- Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Japan
| | - Hidemichi Ito
- Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Japan
| | - Kotaro Oshio
- Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Japan
| | - Yuichiro Tanaka
- Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Japan
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19
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Heger D, Scheer F, Andresen R. Ruptured, Intracranial Dermoid Cyst - A Visual Diagnosis? J Clin Diagn Res 2016; 10:TD08-9. [PMID: 27190918 DOI: 10.7860/jcdr/2016/18017.7702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/18/2016] [Indexed: 11/24/2022]
Abstract
Dermoid cysts are a very rare entity of intracranial tumours. The traumatic or non-traumatic rupture of the cyst wall is a serious complication that can be treated surgically or conservatively depending on the clinical symptoms. However, more common entities have to be considered as a differential diagnosis. We report on a female patient who was admitted with complaints of significant, prolonged headache and diffuse pain. Analysis of her blood and cerebrospinal fluid indicated no clear pathology. A CT examination of the head revealed a ruptured dermoid cyst adjacent to the left sphenoidal bone. An additional MRI was conducted to confirm the CT findings and rule out an intracranial ischemia or vasospasms. A conservative therapy was scheduled and the patient recovered well. Using current imaging techniques, especially magnetic resonance imaging, it is possible to identify a ruptured dermoid cyst by its pathognomonic signal behavior and rule out potentially life threatening complications.
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Affiliation(s)
- Dominik Heger
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel , Lübeck and Hamburg, Germany
| | - Fabian Scheer
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel , Lübeck and Hamburg, Germany
| | - Reimer Andresen
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel , Lübeck and Hamburg, Germany
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20
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Platt S, Hicks J, Matiasek L. Intracranial Intra-arachnoid Diverticula and Cyst-like Abnormalities of the Brain. Vet Clin North Am Small Anim Pract 2015; 46:253-63. [PMID: 26704659 DOI: 10.1016/j.cvsm.2015.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Primary intracranial cystic or cyst-like lesions include intra-arachnoid, epidermoid, dermoid, and choroid plexus cysts. Differentiation of these cystic lesions can usually be accomplished by imaging studies alone; however, some cysts are similar in appearance and require histopathology for definitive diagnosis. Clinical signs often reflect the location of the cysts within the intracranial cavity rather than the type of cyst. If clinical signs are significant and progressive, surgical removal is warranted and may be successful, although cystic contents could be harmful if allowed to contact surrounding brain parenchyma or meninges.
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Affiliation(s)
- Simon Platt
- Neurology and Neurosurgery Service, Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, 2200 College Station Road, Athens, GA 30602, USA.
| | - Jill Hicks
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, 2200 College Station Road, Athens, GA 30602, USA
| | - Lara Matiasek
- Neurology Referral Service, Tierklinik Haar, Keferloher Strasse 25, 85540 Haar, Germany
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21
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Abstract
Intracranial dermoid cysts are congenital tumors of ectodermal origin. Rupture of these cysts can occur spontaneously, but rupture in association with trauma is reported infrequently. The diagnosis of rupture is made by the presence of lipid (cholesterol) droplets in the subarachnoid spaces and ventricles. Nonenhanced CT of the head demonstrates multiple foci of low attenuation that correspond with hyperintense signal on T1-weighted MRI. We present a case of an adult patient with rupture of an intracranial dermoid cyst, precipitated by minor trauma.
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22
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Kirthi V, Tavare AN, Hoffman J, Pelosini L. A case of presumed post-traumatic pneumocephalus. BMJ Case Rep 2015; 2015:bcr-2015-210480. [PMID: 26516242 DOI: 10.1136/bcr-2015-210480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Varo Kirthi
- Department of Ophthalmology, East Surrey Hospital, Redhill, Surrey, UK
| | - Aniket N Tavare
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Jeremy Hoffman
- Department of Ophthalmology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Lucia Pelosini
- Department of Ophthalmology, East Surrey Hospital, Redhill, Surrey, UK
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23
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Mishra SS, Das D, Das S, Panigrahi S. Ruptured intradiploic dermoid cyst into an extra dural hematoma in a traumatic brain injury patient. INDIAN JOURNAL OF NEUROTRAUMA 2014. [DOI: 10.1016/j.ijnt.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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Sood S, Gupta R. Susceptibility artifacts in ruptured intracranial dermoid cysts: a poorly understood but important phenomenon. Neuroradiol J 2014; 27:677-84. [PMID: 25489890 DOI: 10.15274/nrj-2014-10090] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/19/2014] [Indexed: 11/12/2022] Open
Abstract
Rupture of intracranial dermoid cyst is a rare event. The classical imaging feature is described as a fat-containing lesion with tiny fat droplets in the subarachnoid or ventricular system. The lesion and the fat droplets show susceptibility blooming artifact on susceptibility-weighted images (SWI). Knowledge of this fact is important because these lesions mimic the blooming artifact of haemorrhage on SWI. The cause of the susceptibility artifact in intracranial dermoids has not been reported in the literature to date. We describe two cases of ruptured intracranial dermoids in the basifrontal region and review the clinical and imaging features and possible causes of susceptibility artifacts in intracranial dermoid cysts.
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Affiliation(s)
- Shashank Sood
- Department of Radiology and Imaging, Medanta - The Medicity; Gurgaon, India -
| | - Rajiv Gupta
- Department of Radiology and Imaging, Medanta - The Medicity; Gurgaon, India -
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