A 20-year-old female presented with episodic occipital headaches and imbalance on walking of 2 years duration. Neurological examination showed hyper-reflexia of all four limbs. Computed tomographic (CT) brain scan showed a hyperdense lesion in premedullary cistern [Figure 1a]. Magnetic resonance imaging (MRI) of brain revealed a well-defined extra-axial lesion, 13 × 25 × 14 mm in dimensions with marked hyperintensity on T1-weighted images (T1WI) and hypointensity on T2-weighted image (T2WI). The lesion did not show any restriction of diffusion on diffusion-weighted imaging (DWI) and no enhancement on giving gadolinium [Figure 1b-g]. Gradient echo (GRE) sequence of MR imaging did not show any blooming [Figure 1h]. Based on the imaging features, a diagnosis of a high protein-containing cystic lesion was postulated. During surgery by suboccipital approach, a thin-walled extra axial cyst containing pearly and pultaceous material with viscous fluid was excised. There was no evidence of calcification. Patient was relieved of her symptoms after the surgery and was well at follow-up of 2 years. On histopathological examination, the cyst wall consisted of lamellated keratinizing squamous epithelium suggestive of epidermoid cyst [Figure 2a and b].