RESUMEN
BACKGROUND: Intrameningeal cysts are rare lesions without definitive etiologies that can involve the dura or arachnoid mater. Spinal arachnoid cysts have been described, and several different etiologies have been hypothesized. This includes one-way valve mechanisms, traumatic herniation of arachnoid through the dura, and abnormal arachnoid membrane proliferation. To the authors' knowledge, no such descriptions exist regarding purely dural-based cystic lesions; however, the authors hypothesize similar mechanisms may be involved. Most notably, a traumatic injury to the dura leading to a one-way valve mechanism may allow for egress of cerebrospinal fluid between the dural layers, splitting them open. This progressive enlargement can lead to displacement of neural elements and subsequent neurological compromise. METHODS: We describe a 17-year-old girl who presented with progressive neck and back pain, left upper-extremity numbness, bilateral lower-extremity weakness, paresthesias, and numbness without obvious etiology despite an extensive neurologic investigation. She had undergone conservative management options including multiple medications, physical and chiropractic therapy, and epidural steroid injections. Computed tomography myelography revealed a cerebrospinal fluid leak into the lumbar epidural space for which surgical exploration was performed. Despite utilizing fluoroscopy and intrathecal fluorescein, no leak source was identified. Fluid collection was found contained within the dural layers rather than the epidural space. RESULTS: An intracystic blood patch was performed with near-complete resolution of the lesion by 6-week follow-up and near-complete return of neurologic function. CONCLUSIONS: Ventral panspinal cysts are an exceedingly rare cause of radiculopathy and myelopathy that can be resolved by an intracystic blood patch.
Asunto(s)
Quistes Aracnoideos , Enfermedades de la Médula Espinal , Adolescente , Quistes Aracnoideos/diagnóstico por imagen , Quistes Aracnoideos/etiología , Quistes Aracnoideos/cirugía , Duramadre/cirugía , Femenino , Humanos , Hipoestesia , Imagen por Resonancia Magnética/efectos adversos , Mielografía/efectos adversos , Enfermedades de la Médula Espinal/cirugíaRESUMEN
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Asunto(s)
Humanos , Masculino , Adulto , Quistes Aracnoideos/diagnóstico , Compresión de la Médula Espinal/etiología , Evolución Clínica , Quistes Aracnoideos/etiología , Quistes Aracnoideos/cirugía , Compresión de la Médula Espinal/diagnóstico , Espectroscopía de Resonancia MagnéticaRESUMEN
Cervical spine manipulation has been associated with several disorders such as cervical arteries dissection, but rarely has a relationship with intracranial hypotension been reported. We describe a patient showing intracranial hypotension syndrome following chiropractic cervical spine treatment. Magnetic resonance showed the presence of dural leakage at cervical level, suggesting the pathogenesis of the syndrome. We state that cervical spine manipulation should be considered a treatment with risk of neurological complications, including the occurrence of intracranial hypotension.