AIRP Best Cases in Radiologic-Pathologic Correlation: Spinal Conus Dermoid Cyst with Lipid Dissemination

Abstract

History A 67-year-old woman presented with an 18-year history of progressive back pain with lower extremity weakness, which was worse on the left, and bowel and bladder dysfunction. The patient described having no bowel control and urinary incontinence that had required intermittent Foley catheterization during the past year (the year before presentation). The findings from the remainder of the patient’s history were noncontributory. The findings at physical examination did not disclose any cutaneous abnormalities of the back. There was clubbing of the toes of the left foot, with diminished sensation of the sacral dermatomes, decreased vibration sense (pallesthesia) in both feet, and weakness of the left toe flexors and extensors. Ankle reflexes were 1+ bilaterally. The knee jerk reflex was 1+ on the right and 2+ on the left. The findings from cystoscopy and urodynamic testing demonstrated an atonic bladder with marked sensory deprivation.