Extensive spinal intradural arachnoid cyst exhibiting a “double cord sign” on magnetic resonance imaging

Abstract

however, motor power at the C8-T1 level of the right unaffected side was impaired and included finger abduction and finger flexion, which decreased to 4/5. During the second operation, the arachnoid cyst was exposed by performing a right unilateral laminectomy.The patient's neurologic symptoms were improved without neurologic sequelae. Conclusion: In the case of an extensive cyst that exhibits a double cord sign, an intradural arachnoid cyst should be suspected as a differential diagnosis. Without radical excision of all lesions, neurologic symptoms can be recovered by performing selective resection and CSF normalization can be achieved even at extensive levels.

Review/Perspective On the Diagnosis and Surgical Management of Spinal Arachnoid Cysts

“…[ 2 - 23 ] In the cervical/thoracic regions they often demonstrate the “double cord” or “windsock signs”. [ 14 ] Alternatively, in the lumbar spine they may contribute to the “fake arachnoiditis sign,” signaling the presence of a circumferential subdural arachnoid cyst that centrally traps the cauda equina, making it appear as if adhesive arachnoiditis (AA) is present; in fact, AA is absent. Further, for IDAC some of these studies will document multiple intra-arachnoidal septations.…”

“…Intradural/extramedullary or subdural/extra-arachnoidal arachnoid cysts (IDAC) account for 10%[ 12 ] of all arachnoid cysts [ Table 1 ]. [ 8 , 12 , 14 , 15 , 19 , 23 ] Many authors warn that IDAC should be strongly considered in patients who present with the chronic, subactue, or acute onset of a progressive cervical quadriparesis, thoracic paraparesis, or lumbar cauda equina syndrome. [ 7 , 8 , 10 , 12 , 14 , 15 , 19 ] IDAC lesions occur due to the disruption of the arachnoid membrane with/without a dural laceration, either on a congenital, spontaneous, traumatic (i.e.…”

“…Three studies, involving 6 patients were variously attributed to spontaneous or non-surgical/non-traumatic IDAC [ Table 1 ]. [ 8 , 10 , 14 ] Gomez et al . (2011) studied 4 patients with compressive thoracic dorsolateral (3 patients) or ventral (1 patient) IDAC; surgery, performed in 3 cases (i.e.…”

“…evaluated a 43 year old female with a left hemiparesis attributed to an MR-documented massive C6-T12 IDAC. [ 14 ] The MR clearly showed IDAC’s classical “double cord sign” along with demonstrating multiple intradural cyst septations resulting in marked cord compression. [ 14 ] After the initial T5-T7 laminectomy for resection of the cyst wall (i.e.…”

“…[ 14 ] The MR clearly showed IDAC’s classical “double cord sign” along with demonstrating multiple intradural cyst septations resulting in marked cord compression. [ 14 ] After the initial T5-T7 laminectomy for resection of the cyst wall (i.e. level of maximal cord compromise), the patient developed a new right-sided C8/T1 deficit.…”