Evolving magnetic resonance spinal cord trauma in child: from hemorrhage to intradural arachnoid cyst

Abstract

Acquired arachnoid cysts of the spinal cord are uncommon causes of spinal cord compression in the pediatric group. Meningitis, trauma and hemorrhage are considered to be causative or contributing factors. Interestingly, no spinal arachnoid cysts have been reported in patients after subarachnoid hemorrhage or meningitis, conditions expected to cause arachnoid scarring. We describe a child of 1 year and 10 months with thoracic spine trauma with crural paraplegia and anesthesia at level T5 submitted to serial magnetic resonance imagery at 5 days and 18 months, after trauma showing evolution from subarachnoid hemorrhage and adhesions of the arachnoid space to a posterior hyptertensive thoracic intradural arachnoid cyst.

Thoracic Intradural Arachnoid Cyst Associated With Surgical Removal of Epidural Hematoma-Case Report-

“…In one case, arachnoid loculations filled with CSF were observed in the thoracic spine by MR imaging 5 days after spinal injury. 3) The second hypothesis is that the arachnoid cyst was present before initial surgery. Our patient had no history of coagulopathy, anticoagulation, infection, or trauma which might have caused the spinal epidural hematoma, so the intradural arachnoid cyst might have been involved in the development of the hematoma.…”

“…Other etiologies including trauma or inflammation have been also reported. 3,14) Spontaneous spinal epidural hematoma is rare, and manifests as acute onset of severe back pain followed by neurological deficits. Early surgical treatment and the preoperative neurological condition normally determine the neurological outcome, 9) although spontaneous recovery has been reported.…”

“…2,4) The pathogenesis of this entity is not clear, however congenital, traumatic, or inflammatory etiologies have been reported. 1,3,8,10,11,14,15) Spinal intradural arachnoid cyst and spinal epidural hematoma are well-known entities, but no association has been reported. Here we describe a case of intradural arachnoid cyst of the thoracic spine which developed at the same location after surgery in the dorsal subarachnoid space for ventral epidural hematoma.…”

Pathophysiology, Diagnosis, and Treatment of Spinal Meningoceles and Arachnoid Cysts

“…Most frequently they occur in the thoracic spine (70%) or at the thoracolumbar junction (12%), but they can also be found in the lumbosacral (13%) and cervical (3%) spine 12 . Men and women seem to be equally affected, usually in the third through fifth decades of life 14 .…”

“…For our purposes the discussion here will be restricted to intradural arachnoid cysts. Arachnoid cysts are expanding lesions covered by a lining of arachnoid-like cells 6,12 . Histologically, cells lining arachnoid cysts do not immunostain with antibodies against GFAP, S-100, transthyretin (prealbumin), and CEA, helping to differentiate arachnoid cysts from epithelial cysts 13 .…”