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Case Report

LIPOM A AN D INCOMPLETE AGENESIS OF THE

CORPUS CALLOSUM ASSOCIATED WITH ARACHNOID

CYST LOCATED IN THE TEMPORAL POLE: CASE REPORT

İlhan Elmacı, M .D . / Baha Adam , M .D . / Serdar Ö zgen, M .D .

Necmettin Pam ir, M .D .

D e p a r t m e n t o f n e u r o s u r g e r y , S c h o o l o f M e d i c i n e , M a r m a r a U n i v e r s i t y , I s t a n b u l , T u r k e y .

ABSTRACT

This is a rare ca se of c o rp u s c a llo s u m lipom a a p p e a rin g w ith an in tra c ra n ia l a ra ch n o id cyst located in the te m p o ra l pole. T his c a se has been in c id e n ta lly d ia g n o s e d by cra n ia l c o m p u te rize d to m o g ra p h y and m a g n e tic re s o n a n c e im aging.

Key W ords:

A ra c h n o id cyst, C o rp u s callosum , In tra cra n ia l lipom a, T e m p o ra l pole.

IN TR O DUCTIO N

L ip o m a s of th e c o rp u s c a llo s u m are co n gen ital a n o m a lie s w h ich fre q u e n tly a p p e a r w ith m idline s tru ctu ra l d e fe c ts such as a g e n e s is of the co rpus ca llo su m and sp in a b ifid a (1,2). T he c o e xiste n ce of a ra c h n o id cysts w ith in tra c ra n ia l lip o m a s is very rare. A fte r a re v ie w of th e lite ra tu re only one case w a s fo u n d (3).

CASE REPORT

A 2 5 -y e a r-o ld w o m a n a d m itte d to o u r clin ic b e c a u s e of head tra u m a and c o m p la in ts of h e a d a c h e a n d n a u s e a had no n e u ro lo g ic a l

deficit. C om p u te rize d to m o g ra p h y (CT) study revealed a h ypode nse lesion (-17.2 HU) in the region of the left te m p o ra l pole (Fig. 1). A

F i g . l s C T scan show s a h yp o de n se region (-17.2 HU) at the le ft te m p o ra l pole.

( A c c e p t e d 5 A u g u s t , 2 0 0 0 ) M a r m a r a M e d ic a l J o u r n a l 2 0 0 1 ; 1 4 ( 1 ) : 3 1 - 3 4

Correspondance to: ilhan Elmaci, M.D. - e.mail address: ¡lhanelmacl@yahoo.com

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Ilhan Elmacı, et al

h ypode nse m ass w a s id e n tifie d in th e genu (-122.1 HU) and in the sple n iu m (-108.6 HU) of the co rp u s ca llo su m (F ig .2). M a g n e tic re sonance im aging (M R I) w a s p e rfo rm e d on a 0.5 T esla scanner. T he T 2 -w e ig h te d axial im a g e s revealed an ara ch n o id cyst located in the left te m poral pole (F ig.3). T 1 -w e ig h te d axial im a g e s revealed a right p a ra sa g itta l p e ric a llo s a l lipom a at roof level of the lateral ve n tric le (F ig .4). O n T1- w eighted co ro n a l im a g e s both le sio n s co uld be identified s im u lta n e o u s ly (F ig .5). T he p e ricallosal lip o m a has a c u rv ilin e a r s h a p e , a n d an incom plete a g e n e sis of the co rp u s ca llo su m can be seen on T 1 -w e ig h te d sagittal im ages (F ig .6). W ithin 24 hours the p a tie n t had no co m p la in ts and fu rth e r tre a tm e n t w a s not necessary.

DISCUSSION

Intracranial lipom as are rare le sio n s w hich arise in the m idline ce re b ra l ciste rn s, p a rticu la rly the c a llo s a l c is te rn a n d a re c la s s ifie d as h a m a rto m a to u s c o n d itio n s (4 -8 ). T w o m ain p o stulate d h yp o th e se s co n c e rn in g in tra cra n ia l lipom a are an im p e rfe ctio n of the neural tube c lo s u re and th e fa u lty d iffe re n tia tio n of th e

F i g .2 s CT scan demonstrates a hypodense lesion in the genu (-122.1 HU) and splenium (-108.6 HU) of the corpus callosum.

F i g .3 : T2-weighted MRI shows a lesion of high signal intensity at the left temporal pole.

F i g .4 : T1-weighted MRI shows a right parasagittal pericallosal lipoma.

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Lipoma and arachnoid cyst

prim itive m enings tissue in the intrahem isph eric fissure. C o m m issu ra tio n failure w hich occurs two w eeks after co nceptio n can cause agene sis of the co rpus callosum and could possibly appea r with or w ith o u t lipom a (7,9,10). A rachnoid cysts are deve lo p m e n ta l ano m a lie s usually located in the S ylvian fissure. T h ese congen ital tum or-like lesions arise during the splitting of the arachnoid m em brane (11).

A ssociation of intracranial lipom a with arachnoid cysts w as first reported by R ubio et al. The case w as a 2 5 -year-old w om an w ho had com plained of h e a d a c h e s . M RI s h o w e d le ft te m p o ra l ara ch n o id cyst with a lipom a of corpus callosum . T h e m a n a g e m e n t o f th e p a tie n t w a s don e co n se rva tive ly (3).

Both arachnoid cysts and intracranial lipom as can cause sym ptom s like headache, seizures, and behavio ra l cha n g e s (11-13) and can also ca u se o b s tru c tiv e h y d ro c e p h a lu s or a m ass e ffect according to th e ir location (13). Sylvian lipom as can also provoke functiona l psychosis w ith a u d ito ry hallucina tion (5).

Intracranial lipom as w e re firs t noticed in routine p o s tm o rte m e x a m in a tio n s . T he p re m o rb id d ia g n o sis of these lesions becam e possible after the d e v e lo p m e n t of CT and MRI and these te c h n iq u e s are now w id e ly used since they p ro v id e h ig h ly v is ib le im a g e s o f in tra c ra n ia l lipom as (10,14).

A lth o u g h C T scan show m arginal calcification not seen on MRI, the later techniqu e is the procedure of choice because of the cap a city to obtain c o ro n a l and s a g itta l im a g e s (1 ,1 2 ). C ra n ia l son o g ra p h y m ay be useful for the d ia gno sis of in tra c ra n ia l lip o m a s of n e o n a te s (15). T he reported case of a p e rica llo sa l c u rv ilin e a r lipom a and an in com plete a g e n e sis of co rp u s callosum appea rin g w ith an ara ch n o id cyst located in the le ft te m p o ra l p o le m ay be of g e n e tic a b n o rm a litie s w h ic h re q u ire s fu rth e r investigation.

REFERENCES

I . F r i e d m a n R B , S e g a l R , L a t c h a w R E . C o m p u t e r i z e d t o m o g r a p h y a n d m a g n e t i c r e s o n a n c e i m a g i n g o f i n t r a c r a n i a l l i p o m a . J h i e u r o s u r g 1 9 8 6 ; 6 5 : 4 0 7 - 4 1 0 .

F ig . 5 : T1 -weighted MRI shows the arachnoid cyst and the pericallosal lipoma simultaneously.

F i g .6 : Midline sagittal MRI shows the curvilinear shape of the lipoma and incomplete agenesis of the corpus callosum.

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