A 55 year old female patient presented with progressive back pain of 6 month duration,aggravated on lying down, associated with weakness and numbness of the bothlower limbs for since 4 months. On neurological examination, the tone was foundincreased in both the lower limbs with a subjective power of grade 3/5 in both thelower limbs. Ankle and knee jerks were brisk with hypoaesthesia below D12dermatomes bilaterally, plantars were extensor. A clinical diagnosis of involvement ofD9 spinal level lesion was made. Magnetic resonance imaging (MRI) of the dorsolumbarspine showed an intraduralextramedullary ventrally placed lesion at the D8–D9 vertebral level with significant compression of the spinal cord [Figure 1, 2, 3]. Thelesion appeared hyperintense on T2W image with no contrast enhancement and withsignificant compression and shifting of the cord to the left. After preoperative routinehematological investigations, she underwent operation by laminectomy of D8–D9vertebrae and total excision of the cystic lesion was performed [Figure 4, 5]. Histologicalexamination revealed respiratory type pseudostratified ciliated columnar cells and apathological diagnosis of bronchogenic cyst was rendered [Figure 6]. The patient hadan uneventful postoperative period with subjective improvement of her symptomswith reduced spasticity & improvement of motor grade to 4/5 in both lower limbs.
Bang. J Neurosurgery 2020; 9(2): 146-150
Abstract
Background
Extradural intraspinal cysts are fluid accumulations that appear to be associated with increased motion at vertebral joints.
Case presentation
We report the spontaneous regression of lumbar and lumbosacral cysts (presumably synovial cysts) and the unusual occurrence of an S1–2 extradural intraspinal cyst in a dog. The dog presented with lumbosacral pain. Six extradural intraspinal cysts were observed on high-field magnetic resonance imaging from L5–6 to S1-S2. The cysts between L5–6 and L7-S1 ranged from 0.12 to 0.44cm2 at their largest area. The largest cyst was located at S1–2 (left), measuring 0.84 cm2 at its largest view. The dog was medically managed. A follow-up magnetic resonance imaging scan was obtained 3.5 years after the first imaging. All cysts except the one at S1–2 had reduced in size. Mean reduction in size was 59.6% (35–81%).
Conclusions
In summary, we report a case with multiple extradural intraspinal cysts that underwent spontaneous regression of all but one cyst during a 3.5-year follow-up period. Whether this is a single occurrence, or is part of the natural history of these cysts in the lumbosacral region of dogs, remains to be established. Spontaneous regression of intraspinal cysts had not been described in dogs.
We describe two cases of degenerative intraspinal cyst of the cervical spine that caused a gradually progressive myelopathy. One case had a cyst that arose from the facet joint and the other case had a cyst that formed in the ligamentum flavum. The symptoms improved immediately after posterior decompression by cystectomy with laminoplasty.
Abstract
Background Intraspinal hematoma is a rare complication of acupuncture. A few cases of subdural hematoma or epidural hematoma have been reported, with most of them in a fusiform shape, making the hematomas easy to identify on magnetic resonance imaging (MRI) scans. Case presentation A 49-year-old man presented with back pain that radiated into his lower limb that had appeared during acupuncture of his back. After admission, MRI was performed and indicated an L5/S1 intraspinal mass that had an oval shape, resembling an intraspinal cyst. The patient underwent surgery to remove the mass, which was confirmed to be a hematoma. Conclusion Intraspinal hematomas appear with various intensity signals and shapes on MRI, making its differential diagnosis difficult. A carefully medical history review (to determine if the pain derives from a puncture-type treatment or an injury) and surgical exploration may be helpful for identifying this condition.
A source of bleeding is often not evident during the evaluation of patients with superficial siderosis of the CNS despite extensive imaging. An intraspinal fluid-filled collection of variable dimensions is frequently observed on spine MR imaging in patients with idiopathic superficial siderosis. A similar finding has also been reported in patients with idiopathic intracranial hypotension. The authors report on a patient with superficial siderosis and a longitudinally extensive intraspinal fluid-filled collection secondary to a dural tear. The patient had a history of low-pressure headaches. His spine MR imaging and spine CT suggested the possibility of an underlying vascular malformation, but none was found on angiography. Repair of the dural tear resulted in resolution of the intraspinal fluid collection and CSF abnormalities. The significance of the association between superficial siderosis and idiopathic intracranial hypotension, and potential therapeutic and pathophysiological implications, are the subject of this report.
Lumbar Intraspinal Cyst
