INTRACEREBRAL FRONTAL EPIDERMOID CYST WITH EPILEPSY AS THE FIRST MANIFESTATION

A 22-year-old patient with a history of epilepsy since the age of 12 y ears treated by phenobarbital developed recurrent generalized seizures three years after discontinuing this drug. A computed tomography scan of the brain disclosed an area of decreased density in the right fron tal lobe, with a central calcification and no enhancement after inject ion of a contrast agent. Magnetic resonance imaging (MRI) demonstrated a heterogeneous low signal on T1 images, a high signal on T2 images, and postgadolinium rim enhancement; The lesion was removed surgically, and the histologic study established a diagnosis of epidermoid cyst. The introduction of computed tomography and MRI has added to the preop erative diagnosis of-epidermoid cyst, especially in intracisternal for ms, which can be readily differentiated from the cerebrospinal fluid. Conversely, intracerebral forms do not seem to have any characteristic radiological features, and can resemble a glioma. This indicates a ne ed for obtaining a histologic diagnosis before undertaking radiation t herapy or chemotherapy in patients with a suspected diagnosis of gliom a.