THE FIRST SEIZURE CAUSED BY RUPTURED DERMOID CYST A CASE REPORT

Background and Aim : A first seizure is an unpleasant experience, underlying cause andprobability of recurrence is important for the patient (1,2). Usually 30% adult patient with firtseizure has some abnormal finding on brain computed tomography (2). Dermoid cyst is rareintracranial lesions, and if they are ruptured, causes various symptoms (3). These cysts may beseen in any anatomical regions of the brain and due to their regions, causes different symptomssuch as headache, seizure or hemiplegia. (4, 5) CT scanning and MRI are the best methods fordiagnosis of these patients (6).Methods : A 72 years old female was brought to our emergency department with complain of firstseizure. Her daughter said she had a tonic colonic generalized seizure that lasts about 10 seconds.She was complaint of headache at the time of arrival in the Ed and seizure was stopped. Physicalexamination was normal and she has no past medical history. Spiral axial brain CT scanningdemonstrated a round and sharp lesion with peripheral calcification near pineal gland whichcompress third ventricle. Multiple nodules with fat density were seen in subarachnoid space.Phenytoin was started for seizure prophylaxis and neurosurgery consultation was requested.Results : This is a case report of a first seizure caused by ruptured dermoid cyst. American collegeof emergency physician recommended that patents with some risk factor like age over40 shouldundergo neuroimaging in Ed with first seizure (2). Our patient had a round and sharp lesion on CTscanning and after brain MRI was done, the findings suggest that there was a ruptured dermoidcyst. These cysts are most seen near subarachnoid space and midline of skull base, like our patient(6). Radiological findings include hypo dense lesion on CT scanning and hyper intensity on T1-weighted MRI (6, 7, 8, and 9). Because most of these tumors are seen in young people, surgicalremoval of the tumor is often performed (6, 10). Conclusion : This is a rare case of ruptured dermoid cyst near pineal gland which compress thirdventricle and cause midline shift. Complete cyst resection is preferred treatment.

Keywords:

Seizure , Dermoid cyst , ruptured