Board Review 1 – Case 17

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

In this patient with trigeminal neuralgia, there is a mass in the left cerebellopontine angle which is causing mass effect on the pons and cerebellar peduncle. Its imaging appearance is close to that of CSF on all sequences except diffusion weighted imaging (DWI), on which it is bright.

Lesions of the cerebellopontine angle can be cystic or solid. Cystic appearing masses include arachnoid cysts and epidermoid.

The diagnosis is: epidermoid

Epidermoids of the cerebellopontine angle are inclusion cysts which contain secretions which are bright on DWI, distinguishing them from arachnoid cysts. They tend to have minimal if any enhancement.