Spinal hydatid cyst mimicking arachnoid cyst on magnetic resonance imaging

BACKGROUND: Primary spinal hydatid cysts are uncommon and account for 1% of all cases of hydatid disease. Echinococcus granulosus is most often responsible for the cyst hydatid. Intradural, extramedullary involvement is rare. When the cysts do not demonstrate typical magnetic resonance imaging findings, the differential diagnosis is more complex. METHOD: Case report. FINDINGS: An isolated primary hydatid cyst of the spine in a 35-year-old man that appeared to be an arachnoid cyst on preoperative radiographic examination. CONCLUSION: Hydatid cysts that lack the typical radiographic appearance may be mistaken for arachnoid cysts. Misdiagnosis has serious implications for surgical intervention and long-term care.     

Cine-mode magnetic resonance imaging of a thoracic intradural arachnoid cyst: Case report

We report the appearance of a thoracic intradural arachnoid cyst on cine-mode magnetic resonance imaging (MRI). Based on the operative findings, cine-mode MRI was more sensitive for identifying the intradural location of arachnoid cysts than was conventional MRI. The value of cine-mode MRI in diagnosing this rare entity is discussed.     

Clinical study of spinal intradural arachnoid cyst

Spinal intradural arachnoid cysts (S-IAC) are rarely found and only 80 cases have been reported since 1915. We report two of them. A 68-year-old male had slowly progressive dull pain in both thighs for about 6 years prior to admission. Neurological examination and plain x-ray on admission showed no abnormality. Myodil myelography showed a S-IAC at T4 vertebral level. Surgical treatment of cyst wall excision resulted in success. The other case, a 39-year-old male suddenly noticed monoparesis and sensory disturbance of left leg in the morning. On admission were observed spastic monoparesis of the left leg, analgesia at right T2-3 cord segment and sensory disturbance (hypesthesia, dysesthesia, paresthesia) below T3-4 cord segment on the left side. Plain X-ray showed no abnormality. Myodil myelography revealed a S-IAC at T3-4 vertebral level. This patient was treated not surgically but conservatively because all neurological deficits but numbness in the left leg almost subsided after bed rest. The patient has experienced no neurological deterioration for five years since then. We also discuss the clinical feature, treatment and etiology of the S-IAC, by analyzing these 82 cases. There is a slight male preponderance. The age ranges between 3 and 66 years (mean 38 years). The duration from onset to admission is 2 days to 30 years. Sixty percent (48/80) of the cases were ill far longer than a year (mean 6.7 years). Of 82 cases, 83% suffered from motor disturbance, 70% had sensery disturbance, 62% local pain and 24% urinary with/without fecal disturbance.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case of idiopathic herniation of the spinal cord associated with duplicated dura mater and with an arachnoid cyst

Idiopathic herniation of the spinal cord is a very rare disease, only 2 cases being so far reported in the literature. A 61-year-old man with a gradual loss of power in his lower extremities was diagnosed as intradural arachnoid cyst, and underwent operation. During operation, not only an arachnoid cyst was observed dorsally, but was also duplicated the dura mater ventrally. In the latter lesion, a ventral part of the spinal cord was herniated from a defected area of the dural inner layer. Although this dural inner layer as well as the arachnoid cyst was resected, his clinical symptoms remained unchanged after operation. When a shift of the spinal cord is detected in an image, we should precisely determine the relationship between the spinal cord and the dura mater during operation with consideration of a possibility of the presence of idiopathic herniation of the spinal cord.     

Spinal intradural endodermal cyst located anterior to the cervical spinal cord

Spinal endodermic cysts are rare and may be associated with other congenital anomalies (mediastinal cysts, bony defects of the vertebral body), derive from defective displacement of the endoderm of the intestinal tract or, more rarely, the respiratory one. The authors describe a case of endodermic cyst of the cervical spine localized anteriorly to the spinal cord. In the case we treated the patient was a 17-year-old male who presented hypostenia of the lower limbs accompanied by hyperreflexia and spasticity; physical examination was negative. MRI, CT and CT-myelography documented a well-defined mass situated anteriorly to the spinal cord at C2-C4 level. A total-body CT-scan excluded the existence of other malformations. Surgery was performed via an anterior approach and the cyst completely removed. Histological examination confirmed the endodermal nature of the cyst. At long-term follow-up examination the patient was neurologically intact. Postoperative MRI showed a small residue of the cyst wall without spinal cord compression. Endodermic spinal cysts are very rare intradural lesions, predominantly with an anterior cervical localization, which derive from misplaced embryonic and endodermic cells. In the majority of cases, clinical onset is insidious and has a discontinuous progression. The best diagnostic tool is MRI. Treatment of choice is total surgical removal or emptying of the cyst followed by fenestration.     

Magnetic resonance imaging of a spinal extradural arachnoid cyst

A case of extradural arachnoid cyst in the spinal canal of a 16-year-old male was diagnosed by magnetic resonance imaging. The diagnosis was verified by a metrizamide-enhanced computed tomographic myelogram. An operation with a favorable outcome followed. The noninvasive advantages of magnetic resonance imaging in such a diagnosis are demonstrated by this case.     

Spinal cord astrocytoma with intracranial spread: detection by magnetic resonance imaging

An astrocytoma of the thoracic spinal cord in a 9-year-old boy was treated by partial tumour removal and postoperative radiotherapy. The development of intracranial spread causing cranial nerve signs and diabetes insipidus was detectable only by Magnetic Resonance Imaging. The spread of these tumours and difficulties in diagnosis are discussed together with a review of the current literature.     

Thoracic intradural arachnoid cyst associated with surgical removal of epidural hematoma--case report

A 54-year-old woman presented with a very rare association of spinal intradural arachnoid cyst and spinal epidural hematoma manifesting as paraparesis subsequent to severe back pain. Magnetic resonance (MR) imaging disclosed a ventral epidural hematoma extending from the T-4 to T-6 levels and compressing the spinal cord ventrally. Emergent surgical evacuation of the epidural hematoma was carried out 22 hours after the onset. MR imaging obtained 2 days after surgery showed enlargement of the dorsal subarachnoid space at the T-3 to T-8 levels. The patient could walk independently within 6 months after discharge, but paraparesis recurred 3 years after surgery. MR imaging showed formation of an intradural arachnoid cyst, which compressed the spinal cord dorsally. She underwent arachnoid cystectomy, and recovered ambulation postoperatively. This case of intradural arachnoid cyst of the thoracic spine which appeared after surgical removal of an epidural hematoma at the same spinal level indicates some association between the epidural hematoma and the arachnoid cyst.     

Disproportionately large communicating fourth ventricle associated with syringomyelia and intradural arachnoid cyst in the spinal cord successfully treated with additional shunting. Case report

A 44-year-old woman presented with a rare case of disproportionately large communicating fourth ventricle (DLCFV) associated with syringomyelia and intradural arachnoid cyst in the spinal cord. Ventriculoperitoneal shunt operation was performed for hydrocephalus after subarachnoid hemorrhage. She developed DLCFV, which was then associated with syringomyelia and spinal intradural arachnoid cyst. Shunting of the fourth ventricle improved DLCFV, and then the syringomyelia and arachnoid cyst. Although the aqueduct was patent, independent pressure control of the fourth ventricle and the other ventricles was necessary to improve the symptoms. Shunting of the fourth ventricle should be considered for patients with DLCFV when the symptoms persist despite adequate pressure control of the other ventricles.     

Symptomatic cervical synovial cyst associated with an os odontoideum diagnosed by magnetic resonance imaging: case report and review of the literature

STUDY DESIGN: The first case of a synovial cyst of the upper cervical spine associated with os odontoideum diagnosed by magnetic resonance imaging is presented. OBJECTIVES: To evaluate distinct magnetic resonance imaging findings of a cervical synovial cyst located anterior to the cord and discuss its association with os odontoideum. These findings may guide further investigations. BACKGROUND: Synovial cysts of the spine are uncommon findings. They occur mostly dorsolaterally and with greatest frequency in the lumbar spine and are rarely symptomatic. No association with os odontoideum has been reported before. METHODS: A single subject with symptoms of deterioration in his hand functions was examined by a 2. 0-T magnetic resonance imager. RESULTS: Magnetic resonance imaging of the cervical spine showed an os odontoideum connected to the body of C2 by a synovial joint that had a cystic extension posteriorly compressing the cord. CONCLUSION: Synovial cysts should be considered in the differential diagnosis of an extradural mass of the upper cervical spine. Magnetic resonance imaging should be the choice in the investigation of such cases.