Spinal cord herniation into a congenital extradural arachnoid cyst causing Brown-Séquard syndrome

Abstract

This is a report of a patient who developed sharp intercostal pain and Brown-Séquard syndrome. Displacement of the spinal cord toward an extradural mass was noted at the T4-5 vertebral level on iophendylate myelography and metrizamide computerized tomography myelography. Multiple meningeal diverticular lesions of congenital origin were also found. Surgical correction of the spinal cord, which had herniated into a laterally located extradural arachnoid cyst and become incarcerated, resulted in a complete neurological recovery.

Idiopathic Spinal Cord Herniation Associated With Calcified Thoracic Disc Extrusion-Case Report-

“…1,3) Preoperative myelography, CT myelography, and MR imaging demonstrated the defect at the apex of a thoracic kyphosis or hump of the thoracic spine corresponding to vertebral levels of T-2 through T-10. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Specifically, CT myelography and MR imaging are essential tools for the detection, visualization, and diagnosis of transdural spinal cord herniation. The characteristic findings are sharp ventral or ventrolateral displacement of the spinal cord with narrowing and deformity, and enlargement of the dorsal subarachnoid space with normal CSF flow on the sagittal and axial images.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Such dural defects have been attributed to congenital and acquired factors. Congenital defects include a hiatus in the inner layer of the duplicated dura mater, 1,12,14,15) extra-or intradural cysts or myelomeningocele, 6,9) thinning of the dura mater, 3) and weakness of ventral dural fibers. 4) The proposed pathogenesis of acquired defects includes damage to the dura mater by unrecognized remote spinal trauma, 1,2) vertebral body defect, 5,8,17) and thoracic disc herniation.…”

“…Myelography, computed tomography (CT) myelography, and magnetic resonance (MR) imaging demonstrate this condition as ventral displacement of the spinal cord. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Only 59 cases have been reported since the first in 1974. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] This condition is associated with a ventral dural defect of unknown etiology.…”

Spinal cord herniation into pseudomeningocele after traumatic nerve root avulsion: case report and review of the literature

“…The outcome appears to be favorable in most 3 Spinal cord herniation into a pseudomeningocele in a intraoperative view. The small arrow shows the spinal cord herniation and the large arrow shows pseudomeningocele due to nerve root avulsion surgically treated patients, however, persistent sensory symptoms are observed in some cases [9,10,14,15].…”

“…Idiopathic spinal cord herniation is usually seen ventrally and commonly in the thoracic spine. Furthermore the spinal cord frequently is shifted ventrally or ventrolaterally, so this condition often presents with symptoms and signs as Brown-Séquard syndrome [1,2,9,14]. In contrast, postsurgical spinal cord herniation can be found anywhere in the spinal column [7,12].…”