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[Clinical Picture] A tight squeeze with an intracranial epidermoid brain tumour

An 80-year-old man presented to our hospital with a 4-day history of a throbbing pain in the front part of his head that was not relieved by analgesics. The pain had developed gradually and was not associated with any weakness in his arms or legs, numbness or visual symptoms. His medical history included a diagnosis of an intracranial epidermoid cyst, hypertension, and depression. A full clinical neurological examination showed no abnormalities. A CT scan of his head (appendix) showed no additional changes to those seen in a CT scan and an MRI (figure and appendix) done 4 months earlier; at the time when the epidermoid cyst was first found, it was a 9 cm × 7·5 cm mass in the left parietal region, thinning and scalloping of the skull vault, and a slight midline shift to the right.