White epidermoid cyst of brainstem

White epidermoid cysts are rare intra-cranial lesions with an intrinsic brainstem location, though still rare. The location of the tumour poses radiological confusion and a therapeutic dilemma. Neuroimaging techniques like MRI with diffusion tensor imaging (DTI) in this case proved a useful tool in ruling out other pathologies at this location with certain morphologic similarities. MRI findings indicated a bilobed intra-axial lesion with heterogenous signal intensities on T1 and T2 weighted images. DTI showed splaying of cortico-spinal tracts. The intraoperative cystic nature of the lesion was established, followed by a biopsy report confirming the lesion to be a white epidermoid cyst.