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Isolated thoracic (D5) intramedullary epidermoid cyst without spinal dysraphism: A rare case report.

Mishra SS, Satapathy MC, Deo RC, Tripathy SR, Senapati SB - J Pediatr Neurosci (2015 Apr-Jun)

Bottom Line: Contrast magnetic resonance imaging (MRI) characteristics clinched the presumptive diagnosis.Postoperatively, he improved significantly with a gain of motor power sufficient to walk without support within a span of 6 months.Spinal IECs, without any specific clinical presentation, are often diagnosed based upon intraoperative and histopathological findings, however early diagnosis is possible on complete MRI valuation.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, S. C. B. Medical College, Cuttack, Odisha, India.

ABSTRACT
Spinal epidermoid cyst, congenital or acquired, is mainly congenital associated with spinal dysraphism, rarely in isolation. Intramedullary epidermoid cysts (IECs) are rare with less than 60 cases reported so far; isolated variety (i.e., without spinal dysraphism) is still rarer. Complete microsurgical excision is the dictum of surgical treatment. A 14-year-old boy presented with 4-month history of upper backache accompanied with progressive descending paresthesia with paraparesis with early bladder and bowel involvement. His condition deteriorated rapidly making him bedridden. Neurological examination revealed upper thoracic myeloradiculopathy probably of neoplastic origin with sensory localization to D5 spinal level. Digital X-ray revealed no feature suggestive of spinal dysraphism. Contrast magnetic resonance imaging (MRI) characteristics clinched the presumptive diagnosis. Near-total microsurgical excision was done leaving behind a small part of the calcified capsule densely adhered to cord. Histopathological features were confirmative of an epidermoid cyst. Postoperatively, he improved significantly with a gain of motor power sufficient to walk without support within a span of 6 months. Spinal IECs, without any specific clinical presentation, are often diagnosed based upon intraoperative and histopathological findings, however early diagnosis is possible on complete MRI valuation. Complete microsurgical excision, resulting in cessation of clinical progression and remission of symptoms, has to be limited to sub-total or near-total excision if cyst is adherent to cord or its confines.

No MeSH data available.


Related in: MedlinePlus

Digital X-ray of cervical spine and upper thoracic region (anteroposterior, lateral) without any features of spinal dysraphism
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Figure 1: Digital X-ray of cervical spine and upper thoracic region (anteroposterior, lateral) without any features of spinal dysraphism

Mentions: A 14-year-old boy presented to us with a 4-month history of upper backache associated with progressive descending tingling, and numbness (unpleasant, burning in character), and profound progressive weakness in both lower limbs (LLs) making him bedridden, with early bladder, bowel involvement in form of increased frequency of micturition, and constipation. There was no past history of lumbar puncture, spinal trauma or previous spinal surgery. X-ray revealed no feature suggestive of spinal dysraphism [Figure 1]. Examination revealed spastic paraparesis with motor power of 2/5 around all joints of LLs, exaggerated knee and ankle jerks, extensor plantar with loss of all modalities of sensations below T8 segment bilaterally. Upper limbs, general, and systemic examination were normal. MRI of thoracic spine revealed an irregularly marginated intramedullary mass (2 cm × 2 cm × 1.3 cm) at D5 vertebral level, with fusiform expansion of cord and obliteration of anterior and posterior subarachnoid spaces at the same level. The lesion was hypointense on T1-weighted image [Figures 2a and 3a], hyperintense on T2-weighted image [Figures 2b and 3b], with postgadolinium enhancement peripherally [Figures 2c and 3c].


Isolated thoracic (D5) intramedullary epidermoid cyst without spinal dysraphism: A rare case report.

Mishra SS, Satapathy MC, Deo RC, Tripathy SR, Senapati SB - J Pediatr Neurosci (2015 Apr-Jun)

Digital X-ray of cervical spine and upper thoracic region (anteroposterior, lateral) without any features of spinal dysraphism
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4489056&req=5

Figure 1: Digital X-ray of cervical spine and upper thoracic region (anteroposterior, lateral) without any features of spinal dysraphism
Mentions: A 14-year-old boy presented to us with a 4-month history of upper backache associated with progressive descending tingling, and numbness (unpleasant, burning in character), and profound progressive weakness in both lower limbs (LLs) making him bedridden, with early bladder, bowel involvement in form of increased frequency of micturition, and constipation. There was no past history of lumbar puncture, spinal trauma or previous spinal surgery. X-ray revealed no feature suggestive of spinal dysraphism [Figure 1]. Examination revealed spastic paraparesis with motor power of 2/5 around all joints of LLs, exaggerated knee and ankle jerks, extensor plantar with loss of all modalities of sensations below T8 segment bilaterally. Upper limbs, general, and systemic examination were normal. MRI of thoracic spine revealed an irregularly marginated intramedullary mass (2 cm × 2 cm × 1.3 cm) at D5 vertebral level, with fusiform expansion of cord and obliteration of anterior and posterior subarachnoid spaces at the same level. The lesion was hypointense on T1-weighted image [Figures 2a and 3a], hyperintense on T2-weighted image [Figures 2b and 3b], with postgadolinium enhancement peripherally [Figures 2c and 3c].

Bottom Line: Contrast magnetic resonance imaging (MRI) characteristics clinched the presumptive diagnosis.Postoperatively, he improved significantly with a gain of motor power sufficient to walk without support within a span of 6 months.Spinal IECs, without any specific clinical presentation, are often diagnosed based upon intraoperative and histopathological findings, however early diagnosis is possible on complete MRI valuation.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, S. C. B. Medical College, Cuttack, Odisha, India.

ABSTRACT
Spinal epidermoid cyst, congenital or acquired, is mainly congenital associated with spinal dysraphism, rarely in isolation. Intramedullary epidermoid cysts (IECs) are rare with less than 60 cases reported so far; isolated variety (i.e., without spinal dysraphism) is still rarer. Complete microsurgical excision is the dictum of surgical treatment. A 14-year-old boy presented with 4-month history of upper backache accompanied with progressive descending paresthesia with paraparesis with early bladder and bowel involvement. His condition deteriorated rapidly making him bedridden. Neurological examination revealed upper thoracic myeloradiculopathy probably of neoplastic origin with sensory localization to D5 spinal level. Digital X-ray revealed no feature suggestive of spinal dysraphism. Contrast magnetic resonance imaging (MRI) characteristics clinched the presumptive diagnosis. Near-total microsurgical excision was done leaving behind a small part of the calcified capsule densely adhered to cord. Histopathological features were confirmative of an epidermoid cyst. Postoperatively, he improved significantly with a gain of motor power sufficient to walk without support within a span of 6 months. Spinal IECs, without any specific clinical presentation, are often diagnosed based upon intraoperative and histopathological findings, however early diagnosis is possible on complete MRI valuation. Complete microsurgical excision, resulting in cessation of clinical progression and remission of symptoms, has to be limited to sub-total or near-total excision if cyst is adherent to cord or its confines.

No MeSH data available.


Related in: MedlinePlus