Korean J Neurotrauma.  2019 Oct;15(2):214-220. 10.13004/kjnt.2019.15.e31.

Cervical Cerebrospinal Fluid Leakage Concomitant with a Thoracic Spinal Intradural Arachnoid Cyst

• Han S
• Choi SW
• Park BS
• Lim JW
• Kim SH
• Youm JY

• KMID: 2461131
• DOI: http://doi.org/10.13004/kjnt.2019.15.e31

Abstract

We encountered a very rare case of spontaneous spinal cerebrospinal fluid (CSF) leakage and a spinal intradural arachnoid cyst (AC) that were diagnosed at different sites in the same patient. These two lesions were thought to have interfered with the disease onset and deterioration. A 30-year-old man presented with sudden neck pain and orthostatic headache. Diplopia, ophthalmic pain, and headache deteriorated. CSF leakage was confirmed in C2 by radioisotope cisternography, and an epidural blood patch was performed. While his symptoms improved gradually, paraparesis suddenly progressed. Thoracolumbar magnetic resonance imaging (MRI) revealed an upper thoracic spinal intradural AC, which was compressing the spinal cord. We removed the outer membrane of the AC and performed fenestration of the inner membrane after T3-4 laminectomy. Postoperative MRI showed complete removal of the AC and normalized lumbar subarachnoid space. All neurological deficits including motor weakness, sensory impairment, and voiding function improved to normal. We present a case of spontaneous spinal CSF leakage and consecutive intracranial hypotension in a patient with a spinal AC. Our report suggests that if spinal CSF leakage and a spinal AC are diagnosed in one patient, even if they are located at different sites, they may affect disease progression and aggravation.

Keyword

Cerebrospinal fluid leakage; Intracranial hypotension; Arachnoid cyst

MeSH Terms

Adult
Arachnoid*
Blood Patch, Epidural
Cerebrospinal Fluid Leak*
Cerebrospinal Fluid*
Diplopia
Disease Progression
Headache
Humans
Intracranial Hypotension
Laminectomy
Magnetic Resonance Imaging
Membranes
Neck Pain
Paraparesis
Spinal Cord
Subarachnoid Space

Figure

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  FIGURE 1 Magnetic resonance images showed mild contrast enhancement of meninges.

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  FIGURE 2 Radioisotope cisternography revealed cerebrospinal fluid leakage at the C2 level.ANT: anterior, POST: posterior, RT LAT: right lateral, LT LAT: left lateral.

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  FIGURE 3 Thoracolumbar magnetic resonance imaging showed mild expansion of the subarachnoid space at the upper thoracic levels with contrast enhancement of the arachnoid membrane (A, B). In contrast, the lumbar subarachnoid space became narrow (C, D).

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  FIGURE 4 Magnetic resonance imaging revealed an intradural arachnoid cyst severely compressing the spinal cord at the upper thoracic spine.

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  FIGURE 5 Postoperative magnetic resonance imaging showed that arachnoid cyst was removed completely, compression of the spinal cord disappeared, and the subarachnoid space at the lumbar levels was normalized.

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