Hemorrhagic synovial cyst: An unexpected cause of acute cervical spinal cord compression. Case report

Abstract

Highlights Chronic inflammation of the synovial cyst induces neovascularization of its wall leading to a possible intra-cystic bleeding. The different signal modulations on MRI are due to the variable consistency and density of the cystic fluid. Synovial cyst hemorrhage produces a sudden increase in the size of the lesion with compression of the spinal cord and nerve roots. Surgery is the appropriate treatment in case of synovial cyst with spinal cord compression.

Hemorrhagic cervical juxta-facet cyst presenting with Brown-Séquard syndrome: illustrative case

“…It has been reported that approximately 10% of lesions in the lumbar spine are associated with hemorrhage, but hemorrhagic juxta-facet cysts in the cervical spine are rare, and only 7 cases including our case have been reported so far (Table 1). [6][7][8][9][10][11] The average age of the 7 patients was 71 years old (range, 58-86 years), and the most common location was at the C7-T1 level in 3 cases (43%). Neck or back pain was present in 5 of the 7 patients, and myelopathy progressed rapidly and required emergency decompression surgery in 6 cases.…”

Synovial cysts at the cervicothoracic junction: Illustrative series of three cases

“…However, the cysts may undergo sudden changes, especially if they are exposed to stress. Synovial cysts have been known to spontaneously resolve, [1] increase in size, [5] hemorrhage, [10] calcify, [8] or become infected. [2] is can lead to variable clinical presentations, with some patients presenting with no significant physical examination findings while others can present with severe myelopathy or even Brown Sequard syndrome.…”

“…Gait disturbance Gait disturbance, early myelopathy C5-7 Laminoplasty; C7 laminectomy C2-3 Laminectomy Lyons, 2011 [5] Literature Review Multiple Locations Cervical radiculopathy/myelopathy Various Machino, 2012 [6] (L) C4-5 Myelopathy C3-7 Laminoplasty DS Kim, 2014 [3] (L) C7-T1 Acute myelopathy C7-T1 Laminectomy SW Kim, 2014 [4] (L) C7-T1 Brown-Sequard Syndrome C5-6 Laminoplasty; C7 Laminoctomy Correador, 2015 [2] (L) C5-6 Myeloradiculopathy C4-6 Laminectomy/Fusion Mustroph, 2019 [7] Bilateral C7-T1 Myeloradiculopathy C7-T1 Laminoctomy (bilateral) Radouane, 2020 [10] (L) C7-T1 Neck pain and acute LLE weakness, secondary to hemorrhage (R) C7-T1 Hemi Laminectomy C2-7: Second, third, fourth, fifth, sixth, seventh cervical vertebral bone, T1: First thoracic vertebra, L: Left, R: Right, RVE: Right ventricular enlargement, Bil: Bilateral, LE: Lower extremity, LLE: Left lower extremity another presented with lower extremity weakness and numbness. is is most likely due to a multitude of factors, such as the difference in cyst size and placement, leading to compression of either spinal cord, nerve roots, or both.…”