Multiple spinal extradural meningeal cysts presenting as acute paraplegia

Abstract

<jats:p>✓Multiple spinal extradural meningeal cysts are rare. To the authors' knowledge, there have been only four reported cases in the world literature. The authors report a case of multiple spinal extradural meningeal cysts in a 31-year-old woman presenting with acute paraplegia. Magnetic resonance imaging of the thoracolumbar spine revealed multiple extradural cystic lesions extending from T-7 to T-8 and from T-12 to L-3. Intraoperative findings demonstrated a white, fibrous, and tense cyst filled with cerebrospinal fluid–like colorless fluid. Excision of the posterior wall of the symptomatic cyst was followed by immediate neurological improvement. The examination of the pathological specimen showed a thick duralike layer of collagen and an inner membrane of arachnoid that is often not found in these lesions. The final diagnosis was based on combined imaging, intraoperative, and histopathological findings. The authors review the literature and discuss the etiological, diagnostic, and therapeutic aspects of this lesion.</jats:p>

Multiple Meningeal Cysts Affecting the Whole Craniospinal Axis -Case Report-

“…The origins of spinal meningeal cysts are uncertain, although proposed predisposing factors include associations with Marfan syndrome, inflammation, trauma, surgery, and repeated lumbar punctures. 2) In the present case, none of these factors were present. Longer follow up is needed to ascertain the behavior of untreated intracranial and spinal cysts.…”

“…3,8) Likewise, multiple spinal meningeal cysts are rarely described, and appear to be a indistinct and confusing entity. 2,5) Spinal meningeal cysts have been classified into extradural meningeal cysts without spinal nerve root fibers (Type I), extradural meningeal cysts with spinal nerve root fibers (Type II), and intradural meningeal cysts (Type III) for clinical use. 5) We describe a case of multiple intracranial arachnoid cysts arising at eight different locations with concomitant meningeal cysts located along the whole spinal axis.…”

Spinal extradural arachnoid cysts

“…43 Another interesting cause of acute paraplegia or Brown-Sequard syndrome is herniation of the spinal cord through the dural defect into the silent extradural arachnoid cyst. 42,44,45 In a sub-group of a patients ,symptoms are fluctuating with remission and exacerbation. 5,12,18,25,40,46 The symptoms of such patients are exacerbated by Valsalva maneuver in straining and coughing or by gravitational forces.…”

“…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.…”

“…2,3,6,8,9,13,22,29,36 Mild to moderate kyphoscoliosis might be seen in longstanding lesions and particularly in multiple cysts. 9,26,42,48 In the past, water soluble myelography with the ability to demonstrate the compression of the cord by an extradural mass was the only available method. The cyst could be filled with dye through the communicating dural defect, but only if it was obtained delayed with the patient in supine position.…”