A 26-year-old woman with no previous neurological history, asthma and treated with oral contraceptives, presented with a very intense holocraneal headache accompanied by photophobia, nausea and vomiting without fever for about 24 hours.
The patient came to the emergency room of our hospital. The neurological examination revealed mild rigidity of the neck, right internuclear palsy, rhomberg tambaleante, and left anterolateral during gait, the rest being normal.
A computerized axial tomography was performed with the object of a lesion with negative density (-20 to -67 Hounsfield Units) located in the temporal region as well as multiple ovular images bilateral cisterns and left frontal fat angle interpreted.
With the suspicion of chemical meningitis due to ruptured dermoid cyst, treatment with dexamethasone is initiated at a dose of 4 milligrams every 12 hours.
Magnetic resonance imaging of the brain performed six days after the onset of symptoms revealed an extraparenchymatous mass corresponding to the cyst in the medial region of the left temporal pole that settles occupying the anterior zone of the left adnexal with hyperdiffusion.
Magnetic resonance imaging was completed with T1 and EGD sequences with fat suppression in the distal portion of the gadolinium and collateral branches of fat scattered in the subarachnoid space, calling attention the theoretical accumulation of perforated branches
Figure 1 shows a composition with the most representative neuroimaging of the case.
After the result of this test began treatment with acetylsalicylic acid at doses of 100 mg per day and completed the etiological study of stroke with analytical tests, blood count, lipid profile, study of autoimmunity, anticardiolipin antibodies, serology
Headache responded to the administration of dexamethasone in less than 48 hours and discomfort and instability resolved within 10 days, leaving the patient asymptomatic.
Isolated anteromedial midbrain infarction secondary to vasospasm of the perforating arteries of the temporalencephalic mesormoid was diagnosed in relation to the subarachnoid dissemination of the fat content of a cyst.
According to the patient, the Neurosurgery Department decided to watchful waiting and serial neuroimaging controls, leaving elective surgery in case of symptoms due to tumor compression.
