Intramedullary Cystic Lesion Research Articles

SPIN-05 A CASE PRESENTATION ON ASTROCYTOMA

Abstract Patient initially presented to our facility with a 3 year history of limb weakness. The limb weakness started mainly with the right upper limb associated with pains that were radiating to the neck region. They had visited several local hospitals for treatment but had no improvement. One year later he developed low limb weakness, was on physiotherapy for a long time with no improvement, until 1/12 ago when he developed complete paralysis of both low limbs making him bound to use of wheelchair. He had an accompanied history of cervical and thoracic spine pains that were radiating to the chest. No history of trauma. MRI showed an expansile intramedullary cystic lesion seen throughout the length of the spinal cord with inhomogeneous post contrast enhancement, highly suggestive of astrocytoma. Ddx: Hemangioblastoma. On examination, he was not pale, no jaundice no edema, wheelchair bound, with Scoliosis. Vitals were within normal limit, with muscle atrophy and muscle power- RUL ⅗. LUL ⅘, RLL ⅗. LLB ⅖, with bilateral knee hyperreflexia with significant disuse atrophy. Pain scale 6/10. He was a secondary school student. His parents do menial jobs to support their family and would delay clinic reviews due to lack of finances.

A rare case report of fibrous dysplasia with aneurysmal bone cyst-like changes of femur and innominate bone

Fibrous dysplasia (FD) is a common disorder of the skeletal system in which normal bone deposition and remodelling are disturbed and are replaced by anomalous fibrous tissue of varying stages. The age of presentation may vary depending on the genetic penetration and severity of the disease. Aneurysmal bone cyst (ABC) is a non-aggressive neoplastic pathology wherein there is the presence of blood-filled intramedullary cystic lesions and resultant aneurysm-like dilatation of the involved bone that may be a standalone true neoplasm or ABC-like changes associated with other lesions. Concurrence of FD with ABC-like changes is an uncommon entity with most of such cases involving the craniofacial location. To the best of our knowledge, only two cases of appendicular skeleton FD with ABC could be found in the literature, and neither of them is from the Indian subcontinent. Herein, we report one such case of appendicular FD with concomitant ABC-like changes presenting in the adolescent age group. Prompt and accurate diagnosis guides further surgical management and helps in avoiding inadvertent complications.

A Rare Case of Intramedullary Epidermoid Cyst at Conus with the Review of Literature

Summary: We present a case of young male who presented with history of gradually progressive low backache and bladder incontinence. Clinically he was diagnosed as a case of cauda-conus syndrome. Imaging revealed an intramedullary cystic lesion at conus medullaris with features favoring epidermoid cyst. The diagnosis was confirmed on histopathological examination. Keywords: Epidermoid cyst, Spine, Intramedullary, Conus Medullaris, Magnetic resonance imaging.

Primary Intramedullary Hydatid cyst

Hydatid cysts or Hydatid disease is caused by Echinococcus granulosus infestation. Dogs, wolves, and other carnivores are the definitive host, and human being the accidental intermediate hosts. This disease commonly involves the liver and lungs and rarely involves other organs of the body. Primary intramedullary hydatid cysts are extremely rare and few cases before us have been reported in the literature. There is no pathognomonic sign or symptom for spinal hydatid cyst, mostly compression related symptoms, e.g. radiculopathy, myelopathy, local pain, and pathologic fractures are found. So preoperative diagnosis of spinal hydatid requires the correlation of all the aspects including clinical features, radiology, and lab reports. Surgical management is the best treatment for spinal hydatid cyst with complete excision without cyst rupture being the primary target along with complete neural elements decompression. Here we report a case of a 26-year old male with paraparesis with MRI finding directing towards D9-D10 intramedullary cystic lesion (cystic astrocytoma) which was completely excised and histopathology report favored intramedullary hydatid cyst.

Surgical Resection of Isolated Intramedullary Neurocysticercosis

Introduction: Neurocysticercosis is a parasitic disease caused by the cysticerci of Taenia solium. Central nervous system involvement is endemic in underdeveloped countries and intracranial involvement is the most common presentation. Isolated spinal cord involvement is quite rare and definitive diagnosis in most cases is obtained by anatomopathological evaluation. Case Report: 58 year-old female, from Nicaragua, with a 3-year history of dysesthesia and allodynia on right T5 dermatome, with thoracic spine magnetic resonance imaging (MRI) revealing an intramedullary cystic lesion at the level of T4 and T5 vertebrae with perilesional edema. MRI of the rest of the central nervous system was unremarkable. After initial empirical treatment with intravenous methylprednisolone without clinical or radiological improvement, surgical exploration was proposed, confirming the diagnosis of neurocysticercosis. Conclusion: Diagnosing spinal cysticercosis represents a challenge and should to be considered in patients with intramedullary cystic lesions in endemic areas.

Intramedullary Arachnoid Cyst of the Cervical Spine: Case Report and Literature Review

AbstractIntramedullary arachnoid cysts of the spinal cord are extremely rare benign lesions of unclear pathogenesis. To our knowledge, only 21 cases were reported in the literature, 10 of which involved the cervical spine. We report the case of a 47-year-old female who presented with a symptomatic spinal intramedullary arachnoid cyst (SIAC). Magnetic resonance imaging scan of the cervical spine demonstrated an intramedullary arachnoid cyst at C3-C5 level. The patient had a cervical laminectomy and cysto-subarachnoid shunt with rapid and excellent clinical recovery and no recurrence at 2-year follow-up.Intramedullary arachnoid cysts should be considered in the differential diagnosis of intramedullary cystic lesions of the spinal cord. Their pathogenesis and natural history are not well defined in the literature. However, a cysto-subarachnoid shunt can be performed with excellent long-term clinical and radiological results.

Spinal intramedullary glioependymal cyst presented with paraplegia in an adult

We report a case of intramedullary glioependymal cyst at the level of D11-D12 vertebra in 38 year old male patient, who presented to our hospital with progressive spastic paraplegia. The preoperative magnetic resonance image spine revealed a well-defined intramedullary cystic lesion at D11-D12 level, which was hypointense on T1W1, hyperintense on T2W1 and showing ring type enhancement on post contrast images. The patient underwent D11-D12 laminectomy, durotomy, dorsal midline myelotomy with fenestration and decompression of intramedullary cystic lesion. Biopsy was taken from the cyst wall. The histopathological study of specimen was suggestive of glio-ependymal cyst. Postoperatively patient improved neurologically but there was residual paraparesis at the time of discharge. To the best of our knowledge, only 20 cases have been reported so far. Considering this rarity and reviewing the literature, we present a case of spinal cord glioependymal cyst along with radiological, surgical, pathological and immunohistochemistry findings.

Spinal intramedullary cysticercosis: a case report and literature review

AbstractNeurocysticercosis is an endemic infeccion in Brazil, but the intramedullary cases are rare, 1,2% to 5,8% of all cases. There are only fifty cases reported until January of 2011. Intramedullary neurocysticerosis is a treatable pathology but if misdiagnosed it could lead to irreversible damage. Twenty eight year old female patient, previously healthy, was admitted due to a fall. She had progressive walking difficulties and impaired sensation in both lower limbs two months before admission. Contrast MRI revealed a round intramedullary cystic lesion at T2 e T3. The patient underwent laminectomy from T2 to T3, and the spinal cord was found locally swollen near the exit root at this level. A mielotomy was performed where a round protrusion was seen near the root. Histological examination of the resected sample showed cysticercosis. After surgical excision she received albendazol and streoids. The patient's neurological function postoperatively was unchanged. One week later, the motor power of her lower limbs were grade 4/5, and she could walk without special support. The function of anal sphincter and bladder regained without compromise. She was back to work. This reflects dramatically in an active portion of population since it affects mostly people between 20 to 45 years. So it still represents a challenge and this paper intend to show our experience and by that help future diagnostics.

Nonneoplastic Lesions That Simulate Primary Tumors of Bone

The skeletal system may be affected by a variety of nonneoplastic lesions, which may potentially be confused with primary bone tumors on clinical, radiologic, and pathologic grounds. These conditions include fractures, infections, and reactive and degenerative processes, as well as an array of quasineoplastic entities, such as intramedullary cystic lesions like unicameral and aneurysmal bone cysts; fibro-osseous lesions, such as fibrous dysplasia; and exophytic entities, like osteochondromas. To review clinical, radiographic, and histologic features of nonneoplastic lesions of bone, discussing the difficulties in diagnosis and the differential diagnosis with primary neoplasms of bone. The sources include the more relevant medical literature on the different subjects and case-derived material. Because many nonneoplastic bone lesions may require biopsy or resection, the general surgical pathologist must be familiar with these lesions and be aware that review of hematoxylin-eosin slides is only one of the many steps in the diagnostic process, which also includes review of imaging studies and all available clinical information. Morphologic analysis disconnected from the clinical and radiographic context may lead to misinterpretation.

Intramedullary spinal neurenteric cyst with fluid-fluid level

Spinal neurenteric cysts are rare intradural extramedullary lesions of the spine, commonly located in the cervical and thoracic regions. The majority localize ventral to the spinal cord and are associated with other vertebral anomalies. Here, the authors report a rare case of a 3-year-old boy presenting with a 1-week history of meningismus followed by rapid-onset (over a few hours) paraplegia. Magnetic resonance imaging revealed an intramedullary cystic lesion with a fluid-fluid level in the cervicothoracic region of the spinal cord without associated bony or soft tissue abnormalities. To the best of the authors' knowledge, such clinical and radiological presentation of a spinal neurenteric cyst has never been reported. A brief review of the pertinent literature is presented, and the possible pathophysiology of such a presentation is also discussed.

Intramedullary neurenteric cyst associated with a tethered spinal cord: Case report and literature review

Background:Neurenteric cysts are benign tumors of the central nervous system (CNS) that represent 0.3% to 0.5% of all spinal cord tumors. They are usually extramedullary and found in the lower cervical and thoracic spine. Only 12.2% of neurenteric cysts are documented to be intramedullary.Case Description:The authors report a case of a 35-year-old female that presented with progressive weakness and loss of coordination in her legs. Magnetic resonance imaging (MRI) showed an intramedullary cystic lesion in the thoracolumbar region and a low-lying conus medullaris suggesting tethered cord. The patient was taken to the operating room for detethering of her spinal cord and resection of the lesion. Pathologic examination of the tissue confirmed the diagnosis of a neurenteric cyst.Conclusion:A search of the literature since the advent of MRI showed 29 published cases of intramedullary neurentic cysts. Of the 24 published cases with a follow-up MRI, the average recurrence rate was 25% with a mean follow up of 51 months.

Ventriculus Terminalis in Adults: Unusual Magnetic Resonance Imaging Features and Review of the Literature

ObjectiveThe ventriculus terminalis (VT) in adults is a rare pathology. We report various MR imaging features of the adult VT.Materials and MethodsTen patients were included in this retrospective review.. All patients had undergone magnetic resonance (MR imaging with a surface coil that used two different 1.5T MR systems. All patients had undergone initial and follow-up MR imaging with contrast enhancement using gadopentate dimeglumine. Three patients underwent additional MR imaging using the echocardiogram-gated spatial modulation of magnetization (SPAMM) technique. If a shift in tagging band during the systolic phase was less than half of the band space, it was defined as a "non-pulsatile fluid". Two neuroradiologists independently reviewed these images, while clinical symptoms and outcomes were statistically analyzed between the treated and non-treated group.ResultsAll cases presented an intramedullary cystic lesion in the conus medullaris and showed the same signal intensity as CSF. Three VTs had intracystic septation and cord edema, which were pathologically confirmed after surgery; two of these were associated with kyphotic deformity and spinal arteriovenous malformation. SPAMM-MRI of 3 patients demonstrated non-pulsatile fluid motion within the VT. In the treated group, clinical symptoms improved better than the non-treated group.ConclusionThe adult VT shows some unusual imaging features, including septation, cord edema, and coexistence of a spinal AVM, as well as the typical findings. Surgical maneuvers may be considered as a treatment option in adult VT with progressive neurological symptoms.

Spinal Intramedullary Ependymal Cysts : A Case Report and Review of the Literature

We report a rare case of a spinal intramedullary ependymal cyst in a 46-year-old female and review the 17 pathologically proven cases in the literature. The patient presented with a two-week history of gradually increasing tingling in her left posterior thigh and calf. A preoperative magnetic resonance image revealed a well-defined intramedullary cystic lesion on the ventral side of the spinal cord at the T11 to T12 levels. The lesion was hyper intense in T2-weighted images and hypointense in T1-weighted. The patient underwent a right-side hemilaminectomy at the T11 to T12 levels and fenestration of the cyst wall. After having the cyst wall partially removed and communication established between the cyst and the subarachnoid space, the patient improved neurologically. A histological study of the surgical specimens revealed that the cyst wall consisted of glial cells lined by a simple cuboidal to columnar epithelium. An immunohistochemical examination of the cells lining the cyst wall was positive for S-100 protein, glial fibrillary acidic protein, epithelial membrane antigen, and cytokeratin. We suggest that the optimal treatment of intramedullary ependymal cysts creates adequate communication between the cyst and the subarachnoid space.

Chronic Myelopathy Associated to Intramedullary Cysticercosis

Case report. Discuss an isolated intramedullary neurocysticercosis (NCC) case in an adult patient with chronic progressive onset myelopathic symptomatology with clinical, radiologic, and pathologic correlation. NCC is the most common parasitic infection in the central nervous system. Spinal NCC belongs to the group of extraparenchymal forms of NCC and it is considered an extremely rare form characterized by a distinct clinical entity due to mass effect on the spinal cord. Description of a 62-year-old male patient case who presented with chronic but progressive low cord myelopathy who underwent radiologic investigation through magnetic resonance imaging depicting a thoracic intramedullary cystic lesion at level T11. Surgical excision of the intramedullary lesion was preformed and pathologic study confirmed a cysticercus. There was complete resolution of the neurologic symptoms and follow-up monitoring was unremarkable. Although intramedullary is a rare NCC location, it should be considered in the differential diagnosis in high-risk populations especially when cord compression and myelopathy symptoms are present. Magnetic resonance imaging remains the investigative and follow-up modality of choice, and promptly lesion recognition is fundamental for surgical planning and to improve the patient outcome.

Intramedullary cysticercosis

Intramedullary cysticercosis is a rare form of cysticercosis in the central nervous system. A 55-year-old woman was admitted with low back pain, urinary incontinence, paraparesis and sensory deficit. Her MRI showed a well-defined intramedullary cystic lesion at T7 vertebral level with peripheral enhancement on contrast. She underwent a T7–T8 laminectomy and excision of the lesion. Histopathology revealed the lesion to be a cysticercus granuloma. A postoperative course of albendazole was given. The patient showed significant neurological improvement at follow-up.

Brodie's Abscess Caused bySalmonella enteriticaserovar Senftenberg in a Healthy Child

A 13-year-old girl presented in a local clinic with intermittent left ankle pain for 3 months without any history of trauma. She often had discomfort in walking but with no altered sensation or swelling. The patient was transferred to our hospital for the persistent pain in her left ankle. Fever and other constitutional symptoms were absent at presentation. There was no family history of specific illness and no evidence of any underlying diseases. A physical examination revealed swelling and mild tenderness of her left ankle. She had no systolic murmur or other specific findings. She undertook simple radiography and magnetic resonance imaging (MRI). Preoperatively, blood examination revealed a leukocyte count of 6.0×10/L (reference range, 4.0∼10.0×10/L) with neutrophils in 54%, a hemoglobin level of 12.5 g/dL (reference range, 12∼14 g/dL) and a platelet count of 398×10/L (reference range, 140∼ 450×10/L). C-reactive protein level was at 0.08 mg/dL (reference range, 0∼0.5 mg/dL), and an erythrocyte sedimentation rate at 6 mm/hr (reference range, <25 mm/hr). A preoperative simple radiography of lower extremity showed well-defined lytic lesion in the metadiaphyseal region of the left distal tibia (Fig. 1). MRI of the left ankle using T1-weighted and T2-weighted MRI showed a well-defined and bilobed intramedullary cystic lesion in metadiaphysis of left distal tibia about 18 mm in diameter and 40 mm in length. This lesion revealed uniform rim enhancement, marrow edema and thin periosteal reaction, and no definite cortical disruption nor soft tissue mass was noted (Fig. 2). A percutaneous needle biopsy of the lesion showed an intracortical lytic lesion with a tiny, hyperdense focus at its center and revealed chronic inflammatory tissue reaction. She underwent a surgery for the debridement of Brodie’s abscess. Aspirates of abscess during the operation were cultured sequentially and yielded Salmonealla spp., group E by performing Gram stain, Salmonella/Shigella and triple sugar iron agar findings, and antisera grouping with no other pathogenic colonies. S. enterica serovar Senftenberg was finally identified by conventional and molecular identification methods at the Institute of Health and Environment in Daegu. Antimicrobial susceptibility test was done by VITEK system (bioMerieux VITEK, Hazelwood, MO, USA) and revealed susceptible to ampicillin, cefotaxime and ciprofloxacin except trimethoprim-sulfamethoxazole. The infection was successfully treated with operational curettage and intravenous cefotaxime. After 2 weeks of the treatment, cefotaxime was changed to per oral and she returned to outpatient clinic.

Intramedullary bronchogenic cyst of the conus medullaris

Spinal bronchogenic cysts are rare congenital lesions. The authors describe their experience in the treatment of a 17-year-old boy who presented with back pain and paresthesia in both lower extremities. Lumbar MR imaging revealed the presence of an intramedullary cystic lesion at the conus medullaris and histopathological analysis revealed a bronchogenic cyst. To the best of the authors' knowledge, this is the first report of an intramedullary spinal bronchogenic cyst arising at the conus; all previously reported spinal bronchogenic cysts were either intradural extramedullary or not located at the conus.

Imagerie des lésions kystiques du canal rachidien chez l’adulte

Intrarachidian cystic lesions are frequent, with highly varied causes. They can be classified according to their location into intramedullary cystic lesions and extramedullary cystic lesions. In these two categories, they can then be regrouped according to the tissue from which they develop. MRI is the first-choice examination for the study of the intracanal contents and the differential diagnosis between the various lesions.

Kyste arachnoïdien intramédullaire symptomatique. À propos de deux cas et résumé de la littérature

Objective The objective of this work is to present and discuss the rare situation of curable medullary compression with favorable prognosis. Material and method Two cases of thoracic intramedullary arachnoid cysts are described. Clinical, paraclinical, therapeutics and outcome features are discussed with a review of the literature. Results Two children, 4 and 8 years old, with an uneventful history were admitted for progressive spastic paraparesia. MRI demonstrated a thoracic intramedullary cystic lesion at level T3-T4 in both patients. The cyst was emptied with partial cyst wall resection via dorsomedial myelotomy. The pathology examination confirmed the diagnosis of arachnoid cyst. The initial clinical signs resolved completely in both patients. Conclusion Thought in children, intramedullary arachnoidian cyst is a potential cause of medullary compression. Direct surgery is the treatment of choice.

Spinal intramedullary arachnoid cyst in a 4-year-old girl: a rare cause of treatable acute quadriparesis

The authors report their experience in successfully treating a 4-year-old girl who presented with sudden onset of quadriparesis that lasted for 20 days. Magnetic resonance (MR) imaging of the spine revealed an intramedullary cystic lesion extending from C-4 to C-6. A C4-6 laminectomy was performed followed by a median myelotomy. The cyst was decompressed and most of the cyst wall was excised. The histopathological findings were consistent with those of an arachnoid cyst. By postoperative Day 3, power had gradually returned to normal in all her limbs. On follow-up reviews at 2 and 17 months, the results of her neurological examinations remained normal. Follow-up MR imaging of the spine at 17 months revealed an intramedullary residual cystic lesion extending from C-5 to C-6, without any mass effect. An intramedullary arachnoid cyst should be considered in the differential diagnosis of an intramedullary cystic lesion.