Parth Avinash Vaishnav1, Iranna Mallappa Hittalamani2, Siddaling Basavaraj Mindolli3, Sachin Shivaji Kapse4, Namit Narinder Garg5

A 42 years male presented to our hospital with an acute onset of severe headache and whole body spasms for 2 hours. There was no fever or any significant medical history. The patient was normotensive and nondiabetic. No other significant family history was found. Physical examination and laboratory tests were normal on presentation. Electroencephalograms showed sharp waves centrally to the left and there was no lateralisation of seizure pattern.
The patient was subjected to Magnetic Resonance Imaging (MRI). MRI showed evidence of a well-defined 45 x 54 x 25 mm (SI x TR x AP) sized well-defined oval intra-axial lesion is noted in the right frontal lobe. The intensity of the lesion was similar and mildly higher than CSF intensity on all sequences (Figures 1-4). It was causing mass effect over surrounding neuroparenchyma over frontal horn of right lateral ventricle and over the body of corpus callosum. No evidence of communication with subarachnoid space or ventricles was noted. There was no evidence of signal abnormalities surrounding the cyst. No evidence of blooming or restriction noted within the lesion. The imaging findings suggested possibility of a glioependymal cyst.
The differential diagnoses are arachnoid cysts, porencephalic cysts, enlarged periventricular cysts, cerebral hydatid cysts, ependymal cysts and epidermoid cysts. Porencephalic cysts usually communicate with lateral ventricle and may show associated gliosis. Arachnoid cysts are typically extra-axial and sometimes may require histopathological correlation to differentiate it from glioependymal cyst. Cerebral hydatid cysts are usually spherical and maybe indistinguishable on imaging. Epidermoid cysts show restriction on DWI imaging, whereas glioependymal cysts do not.