Objective Neurenteric cysts account for 0.7–1.3% of all spinal cord tumors. These rare lesions are composed of heterotopic endodermal tissue. Methods A 26-year-old woman with a 13-month history of severe cervicalgia and brachial paresthesia. Clinically she had mildbilateral brachial paresis (4/5), generalized hyperreflexia and a left Babinski Sign. Past medical history was significant for a cervical fistula closure when she was 1yearold. The superior somatosensory evoked potentials revealed medullary axonal damage with a left predominance. A cervical magnetic resonance imaging of the neck was performed showing a dorsal homogeneous cystic intradural extramedullary lesion with high signal intensity on T2. Computed tomography revealed a Klippel-Feil syndrome. Results A posterior laminectomy and surgical excision were performed without complications. Post-operative follow-up showed a complete recovery of arm strength. The histopathological report confirmed the preoperative diagnosis of neurenteric cyst. Most neurenteric cysts are located in the spine, mainly in a ventral position. A total of 95% of neurenteric cysts are found in the intradural/intramedullary compartment. Symptomatic neurenteric cysts typically appear in the second and third decades of life and are 1.5 to 3 times more common in men. In 50% of the cases, other vertebral malformations have also been reported. In this case, a congenital dorsal enteric cyst and a Klippel-Feil syndrome were observed. Conclusions The intraspinal neurenteric cysts are rare lesions that must be included in the differential diagnosis of a dorsal, intradural cystic structure. The diagnosis may be overlooked, especially in cases of chronic neck pain without neurological deficit. Level of evidence V; Expert Opinion.
Los infartos cerebrales causados por oclusión de las arterias carótidas por apoplejía pituitaria son raros. Un hombre de 25 años, con historia de cefalea frontal y síndrome de seno cavernoso derecho, fue admitido en nuestro hospital con una imagen de resonancia magnética demostrándose una lesión selar con extensión supra e infraselar y hacia el seno cavernoso derecho. Un día posterior a su ingreso presentó cefalea súbita e intensa, deterioro visual, alteración del estado de alerta y signos de herniación. La tomografía computarizada reveló un infarto de la arteria carótida interna derecha. Se realizó una craniectomía descompresiva. El diagnóstico histológico reveló un adenoma hipofisario no funcionante con hemorragia. El status neurológico del paciente mejoró, permaneciendo con hemiplejia izquierda y síndrome de seno cavernoso. Este caso documenta una rara presentación de apoplejía pituitaria con signos de elevación de presión intracraneal causada por infarto cerebral por obstrucción mecánica de la arteria carótida interna.
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