Mehmet HAMAMCI, Refah SAYIN, Melih PEKCAN, Mehmet Çağlar ÖZGÜR

HİDROSEFALİYE YOL AÇAN DERMOİD KİST OLGUSU

İntrakranial dermoid kistler nadir görülen, selim, yavaş büyüyen ektodermal hücrelerin inklüzyonlarından köken alan lezyonlardır. Genellikle asemptomatiktirler; semptomatik olduklarında rüptüre olurlar. Bu durumda kafaiçi basınç artışına, hidrosefaliye, aseptik menenjite ve epilepsiye yol açabilirler. Uzun zamandır olan ancak son 2 aydır sabahları daha belirgin olmak üzere günün her saatinde de devam eden sıkıştırıcı tarzda, bulantı-kusmanın ve otonom bulgularının eşlik etmediği, aura ve foto-fonofobinin olmadığı atipik baş ağrısı tarif eden 17 yaşında bayan hasta Nöroloji polikliniğine başvurdu. Yapılan nörolojik muayenede fundusta venöz dolgunluk dışında patoloji saptanmadı. Atipik baş ağrısı olan hastaya sekonder baş ağrısı nedeniyle beyin bilgisayarlı tomografisi çekildi ve dermoid kiste bağlı hidrosefali bulguları saptandı. Nadir olarak görülen ve görüldüğünde rüptürle sonuçlanan atipik baş ağrısıyla presente 17 yaşındaki bayan hastayı sunmayı değer bulduk.

The Case of Dermoid Cyst Causing Hydrocephalus

Intracranial dermoid cysts are rarely seen, benign and slowly growing lessions origining from ectodermal cells. Although they usually behave asymptomatic, often rupture is seen when they become sympthomatic resulting with an increase in intracranial pressure, hydrosephalus, aseptic menengitis and epilepsy. A 17 year old female applied to the neurology department with an atypical headache without a photo-phonofobia and aura. The patient had suffered from this headache for a very long time but for the last two months headache had become more evident all day long especially in the morning hours turning out to be more tensive during this period, and autonom findings, vomiting and nausea was not accompanying to headache. In the physical examination, no pathology were determined except venous distension in fundus. A cranial computerized tomography was applied to the patient suffering from atypic headache due to the secondary headache causes, and a hydrocephalus resulting from a dermoid cyst was determied. We aimed to present a case of a dermoid cyst, which is rareley seen and have a high risk of rupture when becoming symptomatic, causing an atypic headache in a 17 year old female patient.

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1. Baxter JW, Netsky MG. (1985) Epidermoid and dermoid tumors pathology. In: Wilkins RH, Renganchary SS, eds. Neurosurgery. (669- 688) New York: Mc Graw Hill.
2. Asil K, Gunduz Y, Ayhan LT, Aksoy YE, Yildiz C. Spontaneous rupture of intracranial dermoid tumor in a patient with vertigo: Computed tomography and magnetic resonance imaging findings. Pol J Radiol. 2013;78(4):79-82.
3. Cllallg YH. (2010) Dermoid cyst. In: Diagnostic imaging brain. (7- 14) Salt Lake City, Utah: Amirsys.
4. Brown JY, Morokoff AP, Mitchell PJ, Gonzales MF. Unusual imaging appearance of an intracranial dermoid cyst. Am J Neuroradiol 2001;22:1970–2.
5. McLendon RE. (1996) Epidermoid and dermoid tumors: pathology. In: Wilkins RH, Rengachary SS, eds. Neurosurgery. (2nd ed.) (959-963) New York: McGraw-Hill.
6. Katzman GL. (2004) Dermoid cyst. In: Diagnostic imaging: brain. (7-12) Salt Lake City, Utah: Amirsys.
7. Orakcioglu B, Halatsch ME, Fortunati M, Unterberg A, Yonekawa YB. Intracranial dermoid cysts: variations of radiological and clinical features. Acta Neurochir. 2008;150(12):1227-34.
8. Guidetti B, Gagliardi FM. Epidermoid and dermoid cysts. Clinical evaluation and late surgical results. J Neurosurg 1977;47:12-8.
9. Liu JK, Gottfried ON, Salzman KL, Schmidt RH, Couldwell WT. Ruptured intracranial dermoid cysts: Clinical, radiographic and surgical features. Neurosurgery 2008;62:377-84.
10. Wilms G, Casselman J, Ph. Demaerel, Plets C, Haene I, Baert AL. CT and MRI of ruptured intracranial dermoids. Neurolradiology 1991;33:149-51.
11. Patkar D, Krishnan A, Patankar T, Prasad S, Shah J, Limdi J. Ruptured intracranial dermoids: magnetic resonance imaging. J Postgrad Med 1999;45:49-52.
12. Gualdi GF, Di Biasi C, Trasimeni G, Pingi A, Vignati A, Maira G. Unusual MR and CT appearance of an epidermoid tumor. Am J Neuroradiol 1991;12:771-2.
13. Osborn AG, Blaser SI, Salzman KL, Katzman GL. Diagnostic Imaging Brain. 2th ed. Salt Lake City, Utah: Amirsys 2010;7-15.
14. Bretschneider T, Dorenbeck U, Strotzer M, Roth M, Rummele P, Buettner R. Squamous cell carcinoma arising in an intradiploic epidermoid cyst. Neuroradiology 1999;41:570-2.