A woman with abdominal pain and headache

Abstract

We describe a case of a 27-year-old woman who came to the Emergency Department presenting severe abdominal pain. She was evaluated by a gynaecologist and submitted to pelvic ecography without finding relevant alterations. In the successive hours, she presented severe headache in occipital region and in the posterior neck, poorly responsive to analgesic drugs. A cerebral CT scan was performed and was normal, and the patient came to our Department of Neurology. The neurological examination on admission was normal. This woman had a 7 years of long-lasting history of headache, diagnosed in another hospital as migraine without aura, and she referred a recent and progressive worsening of both the frequency and the severity of the headache. In the suspect of subarachnoidal haemorrhage, a lumbar puncture was performed, and was negative for bleeding, showing only a mild increase in the number of cells (12 leucocytes). Following the lumbar puncture, the patient presented a dramatic improvement of the headache. In the successive days, she lamented sellar hypoesthesia and, when asked, she referred a recent history of urinary and faecal retention. She was, therefore, submitted to an NMR of the lumbar and sacral medulla with evidence of a voluminous extradural formation in the sacral region suggestive for extradural sacral meningeal cyst. She was finally dispatched to the Department of Neurosurgery for surgical asportation of the cyst.

Spinal extradural arachnoid cysts

“…If the condition is diagnosed before the appearance of serious neural impairment chance of excellent recovery is high. 14,17,19,41 However, with occurrence of myelomalacia or cord atrophy the prognosis is less satisfactory. 49 In the subjects with a longstanding history of neurological dysfunction, acceptable recovery is exceptional.…”

“…The spectrum of radicular pain varies from intercostal and abdominal pain to upper or lower limb radiculopathy. 2,19,42 Pain usually increase with time but it can be intermittent in nature. Pain is usually followed with parenthesis of the corresponding limbs and later is ensued with spastic or flaccid paraparesis or quadriparesis.…”

“…26-29 39,40 In symptomatic patients, the clinical picture is generally related to the gradual compression of the spinal cord or cauda equina and the corresponding nerve root affection. [2][3][4][6][7][8]12,13,[17][18][19]24 Duration of the symptoms might vary from one month to a quarter of century. 3,9,13,14,17,18,41 In children, the period prior the correct diagnosis and from diagnosis to surgery is short and is mostly from six to twelve months.…”

“…7,11,20,24 Spinal EACs seems to be more frequent in male patients than female subjects and more common in children and adolescents rather than adults, with peak incidence in the second decade of life. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] In pre MRI era, reports on extradural arachnoid cysts were extremely rare. However, with widespread application of MRI, such cysts are diagnosed earlier and reported increasingly.…”

“…In the literature these cysts mostly appear as a single case reports or small series of two or three cases which indicate the rarity of these cysts. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Spinal arachnoid cysts located extradurally are most often encountered at mid--thoracic or thoracolumbar region. Although, they are also known to occur in the lumbosacral, cervicothoracic and cervical spine in decreasing frequency.…”