Regular dental check-up

A 30-year-old female patient came for a regular dental check-up. She had a history of cranial trauma when she was three years old and got unconscious for an hour. Personal history revealed irritability and drowsiness. 

 

Examination

On physical examination, no abnormalities were disclosed but delayed milestones were reported. Her gait and all sensory examinations were normal while she had a low intelligence quotient (55). On extraoral examination, frontal bossing with hypertelorism along with macrocephaly were observed. Intra-oral examination revealed high arch palate, poor oral hygiene with 47 and 48 being carious, and Angle’s class 1 molar relation. Conventional radiographs revealed a wide table with a granular appearance of the skull. A study of the MRI revealed a well-defined extra-axial cystic lesion in the posterior fossa in the midline communicating with the fourth ventricle. There was associated mild hypoplasia of the cerebellar vermis and the cerebral hemispheres were anterolaterally pushed toward the tentorial margins. The cystic lesion was causing mild indentation on the inner table of the occipital horn. However, the posterior fossa was mildly enlarged in size.