A Typical Intracranial Epidermoid Cyst: A Diagnostic Journey Through MRI

Intracranial epidermoid cysts are rare, benign tumors constituting about 1% of all intracranial tumors, typically presenting in adults aged 20 -40. Atypical variants are even rarer. This report details two cases of atypical intracranial epidermoid cysts. The first case involves a 43 -year -old female with headaches and ataxia. MRI revealed a T2 hyperintense cystic lesion in the left cerebellomedullary cistern, suggesting an atypical white epidermoid cyst. The second case concerns a 69 -year -old female with persistent headaches, neurological deficits, and a seizure. MRI showed a large, irregular extra -axial lesion in the superior cerebellar cistern extending to the right occipito -temporal region, indicative of an atypical epidermoid cyst. These cysts cause symptoms due to mass effect, with headaches being the most common. Diagnosis relies on MRI, showing characteristic T2 hyperintensity and lack of restricted diffusion on DWI. Despite their benign nature, epidermoid cysts can cause significant neurological issues. This article revolves around the findings of both cases with their imaging appearance on various MRI sequences.