Cervical Cerebrospinal Fluid Leakage Concomitant with a Thoracic Spinal Intradural Arachnoid Cyst

Abstract

We encountered a very rare case of spontaneous spinal cerebrospinal fluid (CSF) leakage and a spinal intradural arachnoid cyst (AC) that were diagnosed at different sites in the same patient. These two lesions were thought to have interfered with the disease onset and deterioration. A 30-year-old man presented with sudden neck pain and orthostatic headache. Diplopia, ophthalmic pain, and headache deteriorated. CSF leakage was confirmed in C2 by radioisotope cisternography, and an epidural blood patch was performed. While his symptoms improved gradually, paraparesis suddenly progressed. Thoracolumbar magnetic resonance imaging (MRI) revealed an upper thoracic spinal intradural AC, which was compressing the spinal cord. We removed the outer membrane of the AC and performed fenestration of the inner membrane after T3-4 laminectomy. Postoperative MRI showed complete removal of the AC and normalized lumbar subarachnoid space. All neurological deficits including motor weakness, sensory impairment, and voiding function improved to normal. We present a case of spontaneous spinal CSF leakage and consecutive intracranial hypotension in a patient with a spinal AC. Our report suggests that if spinal CSF leakage and a spinal AC are diagnosed in one patient, even if they are located at different sites, they may affect disease progression and aggravation.

Multiple etiologies of secondary headaches associated with arachnoid cyst, cerebrospinal fluid hypovolemia, and nontraumatic chronic subdural hematoma in an adolescent: A case report

“…In the published literature, we found only two cases of CSF hypovolemia thought to be related to AC. [ 5 , 9 ] Han et al . emphasized that the structural defects of the meninges might cause both the AC and dural defects.…”

“…The hypothesis was that these two conditions did not occur simultaneously coincidentally but that they might be related to each other. [ 5 ]…”

“…In the published literature, we found only two cases of CSF hypovolemia thought to be related to AC. [5,9] Han et al emphasized that the structural defects of the meninges might cause both the AC and dural defects. e hypothesis was that these two conditions did not occur simultaneously coincidentally but that they might be related to each other.…”