Occult intrasacral meningocoele

Abstract

SUMMARY A case is reported of the rare lesion occult intrasacral meningocoele in a 27-year-old woman who developed symptoms for the first time shortly after the birth of her fourth child. The terminology of the condition is discussed and its pathogenesis, mode of presentation, and treatment reviewed.The term 'occult intrasacral meningocoele' first used by Enderle (1932) describes the condition of abnormal dilatation of the meninges within the confines of the sacral spinal canal. Various workers have pointed out that this term is not strictly accurate in that a meningocoele implies a hernial protrusion of the meninges through a defect in the skull or vertebral column. Thus, Howieson, Norrell, and Wilson (1968) prefer to speak of 'expansion of the subarachnoid space in the lumbosacral region'. In two of their cases the expanded thecal sac terminated at the normal level, with multiple neurofibromatosis as an associated feature. It would seem better to reserve the description of Howieson and colleagues for these latter cases. The prolongation of the subarachnoid space beyond the normal level is probably better described as a caudal diverticulum of the thecal sac. In practice, there is much in favour of retaining the designation 'occult intrasacral meningocoele' if the original idea of an abnormal prolongation of the meninges within the sacral spinal canal is respected. This would remove the confusion in nomenclature caused by the inclusion of such entities as perineural cysts, meningeal cysts, spinal extradural cysts, and anterior sacral meningocoele. CASE REPORrA 27-year-old woman of Indian descent was seen in consultation one week after onset of numbness which started in the toes of her left foot and spread progressively upwards to involve the whole of the left lower extremity including the buttock. Her gait had deteriorated to the point where she was unable to walk without help. Later, numbness was noticed in the toes of the right foot. She had no pain or bowel or bladder disturbance. Three months earlier she had given birth to her fourth child and the next day while walking she suddenly developed sharp pain in the lumbar region which radiated into the left buttock and down the left leg and was so severe that she was unable to walk. She was treated conservatively and six weeks later she considered herself to be 'back to normal'. At no time did she have bladder or bowel disturbance. Before this event she had no history of pain in her back or leg nor had she any symptoms suggestive of motor, sensory, or sphincter dysfunction. Her pregnancies and deliveries had all been normal. EXAMINATION Physical examination showed hypotonia and loss of position sense in the left foot, impairment of pain and touch in the left lower limb from L5 to S4, relative diminution of the left ankle jerk but no actual weakness of the limb. Her gait was slow and uncertain with a slight flail movement of the left foot and some outward rotation of the left leg.Routine blood examination showed Hb 13-3 g/lOOml., white cell count 10,OOOc.mm,urea 1...

Rare Combination of Spinal Lesions and Spina Bifida Occulta: Case Report

“…Most benign arachnoid cysts communicate with the subarachnoid space, but some do not (Duncan andHoare 1978, Kendall et al 1982). Characteristically, occult intersacral meningoceles or sacral extradural cysts communicate with the subarachnoid space through a narrow channel (Pool 1952, Lombardi and Morello 1963, Joseph and McKenzie 1970, Crellin and Jones 1973, Lamas et al 1977, Kendall et al 1982. Occasionally this type of cyst also occurs in assocation with spina bifida occulta (Crellin and Jones 1973) or intraspinal lipoma (Pool 1952, Joseph andMcKenzie 1970).…”

“…Characteristically, occult intersacral meningoceles or sacral extradural cysts communicate with the subarachnoid space through a narrow channel (Pool 1952, Lombardi and Morello 1963, Joseph and McKenzie 1970, Crellin and Jones 1973, Lamas et al 1977, Kendall et al 1982. Occasionally this type of cyst also occurs in assocation with spina bifida occulta (Crellin and Jones 1973) or intraspinal lipoma (Pool 1952, Joseph andMcKenzie 1970). In our case the cyst did not communicate with the subarachnoid space, but was covered by arachnoid membrane, so it was not considered to be an intrasacral meningocele, but an arachnoid cyst, despite the lack of histological verification.…”

Intrasacral meningocoele

“…Myelopathy may also be present, probably due to compression of an abnormally low situated spinal cord by the meningocoele (Hauge 1963, Joseph andMcKenzie 1970).…”

The Occult Intrasacral Meningocele

“…Some authors prefer to speak of "expansion of the subaracnoid space in the lumbosacral region" (Howieson, Norrell and Wilson, 1968) or suggest the expression "caudal diverticulum of the thecal sac" (Joseph and McKenzie, 1970) as more appropriate for this entity.…”