Hemorrhagic synovial cyst as an ‘evanescing’ spinal cervical mass: an issue for differential diagnosis

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

“…15 Similarly, hemorrhagic juxtafacet cysts are characterized by neck or back pain due to the rapid enlargement of the epidural lesion. 6,7 In addition, since this lesion arises from a unilateral facet joint, it should be recognized that rapid enlargement, as in this case, can compress the spinal cord laterally and cause Brown-S equard syndrome. In order to prevent misdiagnosis and provide appropriate treatment, it is important to determine the responsible lesion by paying attention to neck pain and the pattern of sensory disturbance as well as acute-onset hemiplegia.…”

“…10 In previous reports, the cause of intracystic hemorrhage was speculated to be trauma in 1 case 6 and oral administration of antiplatelet agents in 2 cases. 7,8 Since the present case had no history of trauma or oral administration of antiplatelet agents, it was speculated that existing mild facet instability of a degenerative cervical spine was involved in the mechanism of cyst formation and intracystic hemorrhage.…”

“…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.…”