Unilateral akathisia and choreoathetosis as an unusual presentation of a frontal lobe dermoid cyst

To consider an unusual presentation of a frontal lobe dermoid cyst. Intracranial masses very rarely present with movement disorders. We describe a highly unusual presentation of an intracranial dermoid with unilateral choreoathetosis, akathisia and facial tics.

A 63-year-old man presented with left-sided akathisia and tardive dyskinesia of his upper limb, attributed to a dermoid cyst in the right frontal lobe. Resection of the cyst led to a complete resolution of his symptoms without neurological deficit.

Pathogenic mechanisms of such symptoms may include compression and ischaemia of the basal ganglia and other nigrostriatal structures, as well as dysfunction of the supplementary motor area and mesolimbic dopaminergic pathways.