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Multiple intradural arachnoid diverticuli: the need for complete myelography
Insights
A spinal arachnoid diverticulum caused a boy's leg weakness and enuresis. A second diverticulum was found and treated, highlighting the need for complete spinal imaging.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Neurology
Background:
- Intradural spinal arachnoid diverticuli are rare congenital malformations.
- They can cause neurological deficits through spinal cord compression.
Observation:
- A 12-year-old boy presented with enuresis, leg weakness, and lower extremity spasticity.
- Initial myelography revealed a lumbar arachnoid diverticulum, treated with a cystopleural shunt, leading to initial improvement.
- Recurrence of symptoms prompted repeat myelography, identifying a second, previously undetected midthoracic arachnoid diverticulum.
Findings:
- The second arachnoid diverticulum was successfully treated with marsupialization.
- Complete myelography is crucial for diagnosing all spinal arachnoid diverticuli.
Implications:
- This case underscores the importance of thorough diagnostic imaging in pediatric patients with spinal abnormalities.
- Prompt and complete diagnosis and treatment of spinal arachnoid diverticuli can prevent long-term neurological sequelae.
Abstract:
A 12-year-old boy presented with enuresis, leg weakness, and lower extremity spasticity. An initial lumbar water-soluble contrast myelogram disclosed an arachnoid diverticulum. After the insertion of a cystopleural shunt, the patient improved and was dry. However, 2 months later the patient became enuretic and developed weakness. Repeat myelography showed a second arachnoid diverticulum located in the midthoracic region. This second diverticulum was treated by marsupialization of the cyst wall to the subfascial space. The authors stress the need for complete myelography in patients with intradural spinal arachnoid diverticuli and present a brief review of the literature.