Intraventricular lipomas are uncommon, congenital malformations of the central nervous system, arising due to abnormal differentiation of the primitive meninx during early embryonic development1. These lesions are composed of mature adipose tissue and constitute less than 0.5% of all intracranial tumors2. The most frequent locations include the pericallosal region, quadrigeminal cistern, and cerebellopontine angle, with lateral ventricular involvement being particularly rare3. Most intraventricular lipomas are detected incidentally during neuroimaging performed for unrelated complaints such as headache or head trauma4. Although typically asymptomatic, large or strategically positioned lesions may cause symptoms including hydrocephalus, seizures, or focal neurological deficits5. Characteristic imaging findings on computed tomography, particularly fat attenuation values and well-circumscribed borders, aid in differentiating these lesions from other intracranial pathologies. Given their benign nature, conservative management with clinical observation is often sufficient in asymptomatic patients. “We present the case of a 52-year-old female who reported with left temporal headache, in whom neuroimaging revealed an intraventricular lipoma located within the left lateral ventricle as an incidental finding”. PATIENT DEMOGRAPHICS Age: 52 years Sex: Female OPD Department: Neurology Date of Presentation: 28th May 2025 Presenting Complaint: Left Temporal Headache Relevant History: Road traffic accident 2 years prior Family History: Non-contributory Known Co-Morbidities: None CASE REPORT A 52-year-old female, presented to the Neurology outpatient department with complaints of persistent pain over the left temporal region for the past few weeks. She described the headache as dull and localized, without radiation. The pain was not associated with nausea, vomiting, dizziness, visual disturbances, photophobia, or phonophobia. She denied any recent history of trauma, seizures, loss of consciousness, or altered sensorium. However, she reported a history of a road traffic accident two years ago. She remained asymptomatic following the incident and did not experience any neurological deficits at that time. Her medical history was otherwise unremarkable. She had no known co-morbidities such as hypertension, diabetes, or thyroid disorders. There was no relevant family history of neurological or genetic conditions. On examination, her vital signs were stable. She appeared alert, oriented, and in no apparent distress. Neurological examination revealed no focal deficits. Her cranial nerves were intact, motor strength and tone were normal, and there were no sensory abnormalities. Cerebellar testing and gait assessment were also unremarkable. Fundoscopic examination revealed no papilledema or signs of raised intracranial pressure. In view of her persistent headache, a “Non-Contrast Computed Tomography (NCCT) scan” of the brain was performed. The scan revealed a well-defined, homogeneously hypodense lesion located within the left lateral ventricle, adjacent to the choroid plexus in the trigone region. The lesion demonstrated fat attenuation with Hounsfield unit measurements ranging between -80 and -100, consistent with an intraventricular lipoma. There was no evidence of calcifications, surrounding edema, mass effect, or hydrocephalus. The rest of the cerebral structures, including the basal ganglia, thalami, posterior fossa, and ventricular system, appeared normal. Mild mucosal thickening was observed in the bilateral maxillary sinuses, which was considered an incidental finding without clinical relevance. Subsequently, a Magnetic Resonance Imaging (MRI) of the brain was performed for further characterization. MRI revealed a well-circumscribed lesion in the left lateral ventricle, located at the level of the trigone, showing hyperintense signal on both T1-weighted and T2-weighted images with signal suppression on fat-saturated sequences, confirming its fatty nature. There was no evidence of perilesional edema, contrast enhancement, hydrocephalus, or mass effect. The MRI findings corroborated the diagnosis of an intraventricular lipoma. The patient was counselled regarding the benign nature of the lesion and reassured. As she exhibited no neurological deficits or radiological features suggestive of complications, conservative management with clinical observation was advised. She was instructed to report any new or progressive neurological symptoms, and periodic follow-up was planned. IMAGES (A) (B) Figure 1: (A) and (B) Axial images show a well-defined, fat density lesion is noted in the region of the left choroid plexus, within the atrium of the left lateral ventricle Figure 2: Coronal images show a well-defined, fat density lesion is noted in the region of the left choroid plexus, within the atrium of the left lateral ventricle. Figure 3: Axial T1 and T1 fat sat image shows a well-defined lesion in the left choroid plexus region, located within the atrium of the lateral ventricle. The lesion appears hyperintense on T1-weighted images and complete signal suppression on T1 fat-saturated images, confirming its fatty nature. Figure 4: T2-weighted and FLAIR Sequences demonstrates a well-defined lesion in the left choroid plexus, located within the atrium of the lateral ventricle appears heterogeneously slightly hypointense to CSF on T2-weighted images, typical for fat-containing lesions. CSF shows suppression on FLAIR but lesion appear bright consistent with its non-fluid and fatty composition.

Intraventricular lipomas are rare congenital malformations of the central nervous system, arising from abnormal differentiation of the primitive meninx during embryogenesis. These lesions account for less than 0.5% of all primary brain neoplasms and are most commonly located along midline structures such as the pericallosal region or quadrigeminal cistern1, 2. Involvement of the lateral ventricles, particularly near the choroid plexus in the trigone region, is considered an uncommon presentation, as demonstrated in our case. Intraventricular lipomas are frequently asymptomatic and incidentally discovered during neuroimaging performed for unrelated complaints. Headache is the most common presenting symptom when symptomatic, particularly when the lesion lies within or adjacent to the ventricular system6. Our patient, a 52-year-old female, presented with a left temporal headache, and an intraventricular lipoma of the left lateral ventricle was identified during neuroimaging. Importantly, there were no associated neurological deficits or signs of raised intracranial pressure. On Non-Contrast Computed Tomography (NCCT), intraventricular lipomas appear as well-circumscribed, homogeneously hypodense lesions with attenuation values ranging between -50 to -100 Hounsfield units, consistent with the presence of mature adipose tissue7. In our case, the lesion demonstrated these characteristic features with a measured attenuation of approximately -80 to -100 HU. It measured around reported in several previous studies but still within the benign, non-obstructive spectrum.4.6x0.9x1.3cm (APxTRxCC) in its largest dimension, making it slightly larger than those Shamsi et al. and Li et al. discussed cases of cardiac lipomas, which, while involving a different anatomical location, emphasize the consistent imaging characteristics of lipomas across organ systems, highlighting the role of CT and MRI in identifying these fat-containing lesions4, 5. Bilir et al. described an incidental intracranial lipoma discovered in a headache patient, which, like in our case, was managed conservatively due to its benign appearance and lack of neurological symptoms6. Kannuki et al. reported a case of an intracranial lipoma of the temporal lobe, further reinforcing the wide anatomical distribution and incidental nature of these lesions8. Karakaş et al. reviewed the clinical and imaging features of intracranial lipomas and emphasized that typical CT findings, particularly fat attenuation, are often sufficient for diagnosis, negating the need for biopsy or surgical intervention9. Fileva et al. compared CT and MRI findings, reaffirming that while MRI offers excellent soft-tissue characterization, CT remains the cornerstone for detecting fat attenuation, crucial in diagnosing these lesions7. Zappi et al. described a case of cerebral intraventricular lipoma associated with sudden death, illustrating that although these lesions are predominantly benign, larger or strategically located lipomas may have life-threatening consequences if left undetected or untreated10. Fortunately, in our patient, there was no evidence of mass effect, hydrocephalus, or neurological deterioration, supporting a conservative approach.

We concluded that intraventricular lipomas, although rare, should be considered in the differential diagnosis when patients present with headache, especially when routine clinical examination is unremarkable. Our case highlights the importance of neuroimaging, particularly NCCT and MRI, in accurately identifying fat-containing lesions within the ventricular system. Recognition of characteristic imaging features, including -50 to -100 Hounsfield unit attenuation on CT, prevents unnecessary invasive investigations. In asymptomatic cases or those without mass effect, conservative management with clinical observation remains the standard, safe, and effective approach.

1. Truwit CL, Barkovich AJ. Pathogenesis of intracranial lipoma: an MR study in 42 patients. AJR Am J Roentgenol. 1990 Oct;155(4):855–64. 2. Maiuri F, Cirillo S, Simonetti L, De Simone MR, Gangemi M. Intracranial lipomas: diagnostic and therapeutic considerations. J Neurosurg Sci. 1988 Oct 1;32(4):161–7. 3. Ebouda F. Intraventricular cerebral lipoma [Internet]. Radiopaedia.org; 2021 Jan 15 [cited 2025 Jul 4]. Available from: https://radiopaedia.org/articles/intraventricular-cerebral-lipoma 4. Shamsi F, Bajwa G, Ghalib H. Left ventricular lipoma… a rare case. J Cardiothorac Surg. 2020 May 12;15(1):85. 5. Li YS. Surgical treatment of primary left ventricular lipoma: a case report and literature review. ChangQing Med. 2002;31:167–9. 6. Bilir O, Yavasi O, Ersunan G, Kayayurt K, Durakoglugil T. Incidental finding in a headache patient: intracranial lipoma. West J Emerg Med. 2014 Jul;15(4):361–2. 7. Fileva N, Dimova JD, Zlatareva D, Hadjidekov V. Intracranial lipomas—CT vs. MRI findings. Eur Congr Radiol. 2019. 8. Kannuki S, Okajima K, Sato K, Kusaka K, Matsumoto K. [Intracranial lipoma of the temporal lobe—report of a case and review of the literature]. No Shinkei Geka. 1986 Mar;14(3 Suppl):379–84. Japanese. 9. Karakaş E, Doğan MS, Çullu N, Kocatürk M, Kocatürk Ö, Karakaş Ö, et al. Intracranial lipomas: clinical and imaging findings. Clin Ter. 2014;165(2):e134–8. 10. Zappi E, Zappi M, Breithaupt M, Zugibe FT. Cerebral intraventricular lipoma and sudden death. J Forensic Sci. 1993 Mar;38(2):489–92.