Thoracic Arachnoid Cyst Made Symptomatic by Demyelination.
Anan Shtaya1, Anastasios Giamouriadis2, Matthew J N Crocker2
1Neurosciences Research Centre, St. George's University of London, London, United Kingdom; Atkinson Morley Wing, Neurosurgery, St. George's University Hospital, London, United Kingdom.
World Neurosurgery
|August 22, 2017
Summary
Spinal arachnoid cysts are rare fluid pouches. A patient with demyelination experienced rapid neurological decline due to a thoracic arachnoid cyst, which improved after surgery.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Spinal arachnoid cysts, uncommon pouches of cerebrospinal fluid (CSF), are typically asymptomatic and found incidentally.
- They are usually located extradurally, with intradural cysts being rare.
Observation:
- A patient presented with rapid upper motor neuron neurological deterioration over one week.
- Magnetic resonance imaging revealed central nervous system demyelination lesions and a thoracic arachnoid cyst causing spinal cord compression.
Findings:
- The acute presentation, without trauma, suggested the cyst became symptomatic due to superimposed demyelination.
- Surgical intervention led to improvement in sensory, gait, and lower limb deficits, with residual mild upper limb deficits.
Implications:
- This case highlights a rare presentation of spinal arachnoid cysts becoming acutely symptomatic.
- Demyelination may unmask or exacerbate symptoms in patients with pre-existing, compensated spinal lesions.
- Early diagnosis and surgical decompression are crucial for managing symptomatic spinal arachnoid cysts.
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