Unexpected Cause of Headache in the Emergency Department: Case Report

Introduction Headaches are a frequent complaint in emergency departments, ranging from benign primary causes to serious underlying conditions. This case report presents an unusual cause: a ruptured intracranial dermoid cyst. These rare congenital tumors can suddenly manifest with headache, seizures, or neurological deficits upon rupture [1]. This case highlights the importance of maintaining a broad differential diagnosis when evaluating headaches in emergency settings. Case Presentation A 23-year-old female presented to the emergency department with a 10-day headache and a reported seizure. Initial examination revealed tachycardia of 117 beats per minute and hypertension of 146/100 mmHg. Other vital signs were normal. A neurological examination revealed no significant findings. CT imaging showed a 3.9x3.1x3.5 cm extra-axial fatty density mass in the left anterolateral suprasellar region with multiple fatty inclusions, suggesting a ruptured dermoid cyst. MRI confirmed the diagnosis. The patient was hospitalized, started on Levetiracetam for epileptiform changes detected on EEG, and underwent successful surgical removal of the histologically confirmed dermoid cyst. She was discharged with follow-up recommendations and without any neurological deficit. Discussion This case highlights the importance of recognizing red flags in headache evaluation, such as Todd's paralysis, hypertension, and tachycardia, which necessitated urgent neuroimaging and revealed a ruptured dermoid cyst [2]. These rare congenital tumors, accounting for less than 1% of intracranial tumors, can cause severe complications and require prompt surgical intervention. Their unique histological features, including elements from all three germ layers, distinguish them from other lesions [3]. This case serves as a reminder of the diverse etiologies of headaches and the need for thorough clinical assessment in emergency settings, while also emphasizing the importance of considering rare causes in differential diagnosis. Conclusions This case of a ruptured intracranial dermoid cyst highlights the importance of thorough evaluation, neuroimaging, and vigilance for red flags in headache management. It underscores the value of multidisciplinary care and awareness of rare conditions presenting with common symptoms like headache and seizure.