Conus Medullaris Enterogenous Cyst

Abstract

INTRODUCTIONThis report discusses the unique presentation and outcome of a patient with a conus medullaris enterogenous cyst. The incidence of enterogenous cysts, differential diagnosis, imaging, presentation, and management are discussed. The unique aspects of this case presentation include a patient of advanced age with an atypical enterogenous cyst at clinical presentation and postoperative motor recovery despite prolonged cord compression. CASE PRESENTATIONA 66-year-old white woman presented with a 2-year history of constant pain in her left anteromedial thigh and knee. She had experienced multiple falls due to left knee buckling, although she had experienced no specific left knee injury to cause the weakness. Due to this left lower extremity weakness, she required a walker to ambulate. There was no history of trauma, fever, back pain, recent weight loss, paresthesias, or changes in bowel or bladder. Her medical history was significant for obesity and hypothyroidism. Review of systems was otherwise unremarkable. Results of a physical examination revealed visible left thigh atrophy (thigh circumference was 6 cm smaller on the left side). Manual muscle testing demonstrated left iliopsoas and quadriceps strength of 2/5. Bilateral gluteus medius, hamstring, anterior tibialis, gastrocsoleus complex, and extensor hallucis longus strength, and right iliopsoas and quadriceps strength were all 5/5. Sensory examination was normal for light touch, pinprick, and vibration, with the exception of anesthesia in the left anterior and lateral thigh that extended to the proximal medial tibial region. Deep tendon reflexes were normal, with the exception of an absent left quadriceps reflex. Toes were downgoing bilaterally to plantar stimulation.Electrodiagnostic testing of the bilateral lower extremities and related paraspinals revealed a left L2-L4 radiculopathy (anterior limb muscles and posterior paraspinal denervation evident). There was no evidence of right lumbosacral radiculopathy or plexopathy. Magnetic resonance imaging (MRI) of the lumbar spine without contrast performed to evaluate for a presumed diskal-structural lesion revealed a cystic structure in the distal cord-conus medullaris. A thoracic spine MRI with contrast demonstrated an expansile lesion of T1 and T2 prolongation signal in the distal cord-conus medullaris that was approximately 15 ϫ 15 ϫ 40 mm in the anterior and posterior, transverse, and cephalocaudad diameter, without pathologic contrast enhancement (Figure 1).Initial conservative treatment included physical therapy, adaptive equipment, and observation because the patient was concerned about potential paraplegia with surgical intervention on the distal spinal cord. Needle electromyogram examination demonstrated the presence of active denervation of the left anterior thigh musculature. Physical therapy was initiated to strengthen the involved musculature, to instruct in compensatory gait mechanics and/or assistive device use, and to prevent falls. The strength of the left anterior thigh musculature did...

Bilobed intramedullary and extramedullary bronchogenic cyst of the conus medullaris: illustrative case

“…For this reason, Garg et al 21 advocated for cautious resection of recurrent cysts rather than aggressive initial resection, given that recurrence was not associated with poorer outcomes. 25 This was in keeping with our management of a rare recurrent bronchogenic cyst.…”

Differential gene expression and alternative splicing in insect immune specificity

“…Reactive oxygen species (ROS) are generated by respiration in the mitochondria or as part of the immune response [46]. P450 cytochromes are oxidases acting terminally in monooxygenase systems [47]. Some are regulated in response to infection possibly either as direct immune responders [48], producing nitric oxide (NO) or other reactive oxygen radicals or as part of the host detoxification process decreasing oxidative stress after an infection [46].…”