CASE PRESENTATION :

Male, 30 years old, attended a medical visit referring to headache in the occipital region which started a year ago with progressive worsening of the condition. Associated with this, reports episodes of vertigo, nausea and vomiting. He reported to be in use of paracetamol + codeine phosphate, not getting improvement of the symptoms. By the physical examination: lucid and oriented, without alterations in the cardiac and pulmonary auscultations, preserved strength in limbs, isochoretic and reactive pupils. Prewritten succinate of sumatriptan and betametin dihydrochloride and requested Computed tomography of the skull (CT) that showed a markedly hypodense, oval formation with lobulated contours, density (-90UH), measuring 21x18mm, obstructing the passage of cerebrospinal fluid in the encephalic aqueduct. Patient was then referred to the hospital where Magnetic Nuclear Resonance (MRI) was requested, showing an oval image, with a hyperintense signal in T1, absence of signal in T2 - weighted images, slightly hypointense in T2, and heterogeneous in Flair, located near IV ventricle and to the upper follicles of the brainstem, determining stenosis of the encephalic aqueduct, with consequent hydrocephalus supratentorial, without signs of cerebrospinal fluid transudation. Was performed a thirdventriculostomy, because the hydrocephalus was obstructive.

DISCUSSION:

Intracranial lipomas (LPI) are rare tumors, with an incidence of 0.06-1% of all intracranial tumors. The genesis of LPI is linked to congenital malformations resulting from the persistence of the primitive meninges that differentiate into adipose tissue. The most common sites are the corpus callosum (64%) and the quadrigeminal cistern (13%). Patients with LPI are usually asymptomatic, symptoms when present depend on the size and location of the tumor, and are caused due to compression of adjacent structures, coursing  with headache, seizures, paralysis or mental retard. Diagnosis is performed by examining images such as CT and MRI, showing pathognomonic information of LPI.  Surgical treatment is not recommended in asymptomatic patients because the risks outweigh the benefits, causing high morbidity and mortality.

FINAL CONSIDERATIONS:

Intracranial lipomas are rare tumors, usually asymptomatic. It presents difficult diagnosis, mostly incidental, through the identification of pathognomonic lesions in imaging tests. Treatment is conservative in asymptomatic cases.