A Rare Cause of Headache in the Emergency Department: A Case Report

Intracranial dermoid cysts are rare congenital tumors, accounting for 0.04%-0.6% of intracranial neoplasms. Though often asymptomatic, rupture can cause headaches, seizures, and neurological deficits due to mass effect or inflammation.

We report a 23-year-old female with a 10-day history of persistent headaches, initially relieved by nonsteroidal anti-inflammatory drugs (NSAIDs). Ten days prior, she experienced a seizure with unresponsiveness, postictal disorientation, and left-sided weakness. Vital signs showed nonsignificant abnormalities. Neurological examination was unremarkable, and laboratory tests were normal. Computed tomography (CT) revealed an extra-axial fatty density mass in the left anterolateral suprasellar region, consistent with a ruptured dermoid cyst. Magnetic resonance imaging (MRI) confirmed the diagnosis, and electroencephalogram (EEG) showed epileptiform changes. She was started on Levetiracetam and underwent craniotomy for cyst removal, confirmed histologically. She was discharged with follow-up recommendations. Headaches are a common emergency complaint, classified as primary (e.g., migraines) or secondary (e.g., tumors, infections). Secondary headaches require urgent evaluation. This case underscores the importance of recognizing red flags. Prompt diagnosis enabled definitive surgical treatment, preventing complications such as hydrocephalus or blindness. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the need for a high level of suspicion when evaluating headaches and seizures in the emergency setting. Rapid identification of serious conditions can prevent complications and ensure optimal patient care.