Spinal intradural hydatid cyst causing arachnoiditis: A rare etiology of cauda equina syndrome

Singh, Sanjay; Sardhara, Jayesh; Singh, Amit Kumar; Srivastava, Arun Kumar; Bhaisora, Kamlesh Singh; Das, Kuntal Kanti; Mehrotra, Anant; Sahu, Rabi Narayan; Jaiswal, Awadhesh Kumar; Behari, Sanjay

doi:10.4103/0974-8237.193257

Cited by 11 publications

(10 citation statements)

References 14 publications

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“…[ 7 ] The diagnostic feature is the presence of a markedly hypointense cyst wall on T1- and T2-weighted images. [ 6 ] However, rare location with unusual finding of involvement of intervertebral disc and absence of characteristic features make the diagnosis difficult as seen in the described case. The differentials on radiology include tuberculosis, aneurysmal bone cyst, synovial cyst, traumatic pseudomeningocele, arachnoid cyst, and hemangiomas.…”

Section: Discussionmentioning

confidence: 93%

“…[ 5 ] They can present either with compressive myelopathy or radiculopathy. [ 6 ] MRI is the preferred diagnostic modality when there is a suspicion of hydatid disease. [ 7 ] The diagnostic feature is the presence of a markedly hypointense cyst wall on T1- and T2-weighted images.…”

Section: Discussionmentioning

confidence: 99%

“…[ 8 ] In addition, antihelminthic therapy and prolonged regular follow-up with MRI in postoperative period are mandatory to prevent the recurrence. [ 6 ] Literature describes the recurrence rate of 30%–40% and a mortality of 45%–50% on an average of 5 years after the onset of symptoms. [ 3 9 ] Thus, early and correct diagnosis will improve the management and survival of patients.…”

Section: Discussionmentioning

confidence: 99%

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Hydatid disease of the spine: A rare case

Agnihotri¹,

Goel²,

Shenoy³

et al. 2017

J Craniovert Jun Spine

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Hydatid disease or hydatidosis is the most widespread zoonosis caused by Echinococcus granulosus. Liver and lungs are the most common sites. Bone involvement is rare and reported in 0.5%–4% with spinal involvement reported in 50% of these cases. We present a case of spinal hydatidosis in a 35-year-old male presenting with lower extremity weakness and numbness. Magnetic resonance imaging (MRI) of the spine showed multiple cystic lesions at the T9–T11 level with involvement of the paraspinal muscles. The lesion was seen intraspinal, intradural, intramedullary, and epidural. Radiological impression was aneurysmal bone cyst. The patient underwent laminectomy, and the excised cysts showed characteristic features of hydatid cyst (HC) on histopathology. The patient was started on antihelminthic therapy postoperatively. MRI is a diagnostic modality for HC, but the unusual location and absence of characteristic features can cause diagnostic difficulty. A high index of suspicion should be kept in patients residing in endemic areas and presenting with unusual cystic lesion of spine.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hydatid disease of the spine: A rare case

Agnihotri¹,

Goel²,

Shenoy³

et al. 2017

J Craniovert Jun Spine

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“…Engamba et al reported a case in which a patient presented with CES which resulted from the rupture of an underlying aortic aneurysm [7]. In a report by Singh et al, an 11-year-old boy was determined to have CES, which resulted from an underlying spinal hydatid cyst, which was initially thought to be an intradural extramedullary benign lesion [8]. Metastatic cancer has also been reported to cause CES.…”

Section: Discussionmentioning

confidence: 99%

A Successful Outcome Despite Delayed Intervention for Cauda Equina Syndrome in a Young Patient with a Posterior Epidural Disc Extrusion

Mugge

Caras

Miller

et al. 2019

Cureus

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Epidural disc extrusion is extremely rare and may cause cauda equina syndrome. This is a surgical emergency and needs rapid decompression. Although cauda equina is commonly caused by disc herniation, this is an unusual presentation with epidural disc extrusion. We present a very rare case of Cauda Equina syndrome, resulting from an epidural disc extrusion at L3-L4 level. Patient care and progress notes were reviewed along with pre-, post-, and intra-operative radiological imaging. Here, a 19-year-old male with a past medical history of type I diabetes mellitus, fell asleep on a chair at home in an unusual position and was unable to walk on awakening. The patient developed progressive neurological deficits including bilateral foot drop along with bowel and bladder dysfunction. In addition, he experienced paresthesia and severe lower back pain unresponsive to steroids. Pre-operative magnetic resonance imaging (MRI) demonstrated a herniated disk epidurally with disc extrusion and mass effect and compression at the L3-L4 level, wrapping around the posterior aspect of the dura. A diagnosis of cauda equina syndrome was made and surgical decompression was performed. Using microsurgical technique and fluoroscopic guidance, a bilateral laminectomy of L3 was achieved with bilateral partial laminectomy of L4, with bilateral foraminotomy of L4. After removal of the lamina, a mass was immediately visualized in the posterior epidural space. Further dissection of the substance and following it posteriorly, identified the mass as a portion of the extruded disc. Post-operatively, the patient experienced rapid recovery. In conclusion, this case demonstrates that a disc extrusion can occur within the epidural space and can cause cauda equina syndrome. As this presentation is unusual, surgeons must be aware that they may encounter disc mass in unexpected locations, in a clinically delayed setting, long after the initial onset of symptoms.

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“…Other presenting symptoms include radiculopathy, myelopathy and pathological fractures. 25 , 36 , 42 – 57 However, the patient may be asymptomatic in the early stages of the disease. 42 In a study of 36 patients with spinal echinococcosis, 10 patients presented with backache, and 17 patients experienced variable degree; four patients experienced complete paraplegia, another four patients experienced urinary retention, and one patient experienced quadriplegia.…”

Section: Clinical Presentationmentioning

confidence: 99%

Echinococcosis of the spine

et al. 2021

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Echinococcosis or hydatid disease affecting the spine is an uncommon manifestation of Echinococcus granulosus infection of the spine. More commonly found in endemic areas, it causes significant morbidity and mortality as it grows slowly and produces symptoms mainly by compressing the spinal cord. As diagnostic methods are non-specific, diagnosis and management are usually delayed until the disease is advanced, thereby therapy is usually unlikely. Treatment is usually surgical, aiming at cyst excision, spinal cord decompression and spinal stabilization. This article summarizes the clinical findings of echinococcosis of the spine, discusses the specific laboratory and diagnostic findings, lists the current treatment options, and reviews the patients’ outcomes. The aim is to prompt clinicians to be aware of the possibility of echinococcosis as a possible diagnosis in endemic areas. Cite this article: EFORT Open Rev 2021;6:288-296. DOI: 10.1302/2058-5241.6.200130

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Spinal intradural hydatid cyst causing arachnoiditis: A rare etiology of cauda equina syndrome

Cited by 11 publications

References 14 publications

Hydatid disease of the spine: A rare case

Hydatid disease of the spine: A rare case

A Successful Outcome Despite Delayed Intervention for Cauda Equina Syndrome in a Young Patient with a Posterior Epidural Disc Extrusion

Echinococcosis of the spine

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