Spinal Extradural Arachnoid Cyst: A Case Report

Spinal arachnoid cyst is a rare cause of myelopathy secondary to spinal cord compression. We report a case presenting extradural arachnoid cyst of probable traumatic origin leading to irreversible neurological deficits including paraparesis and neurogenic bladder. The patient presented progressive paraparesis and voiding difficulty. Magnetic resonance imaging (MRI) of the spine revealed long segmental cystic lesion of cerebrospinal fluid (CSF) signal intensity at dorsal extramedullary space of T11 to L3 level suggesting arachnoid cyst with diffuse cord compression. On the operation, an ovoid shaped dural defect was identified at right sided dorsolateral aspect of the dura mater between nerve root sleeves at T11 and T12 level. The patient was treated by microsurgical repair of the dural defect and intraoperative findings revealed no further leakage of CSF. The neurological status of the patient was stationary on follow-up examination postoperatively. We postulate that delayed-onset post-traumatic extradural arachnoid cyst should be taken into consideration on the differential diagnosis of intrapinal cysts.

Factors Affecting Postoperative Recurrence of Chronic Subdural Hematoma / 대한신경손상학회지

OBJECTIVE: Considerable recurrence rates have been reported for chronic subdural hematoma (CSDH) following surgical evacuation. The aim of this study was to determine the independent factors and features of CSDH that are associated with postoperative recurrence. METHODS: Retrospective analysis of 136 consecutive patients diagnosed with CSDH who were surgically treated from September 2005 to December 2011 was performed. The demographic data, clinical characteristics, radiologic features were analyzed to clarify the correlation between independent variables and postoperative recurrence of CSDH. RESULTS: CSDH was resolved within 1 month following surgery in 51 patients (37.5%), between 1 to 3 months in 59 patients (43.4%), and past 3 months in 14 patients (10.3%). A total of 12 patients (8.8%) experienced recurrence of CSDH, and reoperation was performed in all recurred cases. The average duration between initial surgery and reoperation was 20.1 days. Delayed resolution and recurrence were more commonly presented in bilateral CSDH, but this data was not statistically significant. Large hematomas with maximum thickness over 20 mm were significantly correlated with higher recurrence rates of CSDH (p=0.032). In addition, the incidence of recurrence was significantly higher in the cases with high-density and mixed-density hematomas according to brain computed tomography (CT) findings (p=0.0026). CONCLUSION: The thickness and density of the hematoma is significantly correlated with higher recurrence rates of CSDH. Discerning these risk factors could be beneficial in predicting the postoperative recurrence of CSDH.

Femoral Neuropathy due to Iliacus Muscle Hematoma in a Patient on Warfarin Therapy

Spontaneous hematomas of the iliacus muscle are rare lesions and these are seen in individuals receiving anticoagulation therapy or patients with blood dyscrasias such as hemophilia. It can cause femoral neuropathy and resultant pain and paralysis. Although there is no clear consensus for the treatment of femoral neuropathy from iliacus muscle hematomas, delays in the surgical evacuation of hematoma for decompression of the femoral nerve can lead to a prolonged or permanent disability. We report here on a rare case of a spontaneous iliacus muscle hematoma that caused femoral neuropathy in a patient who was taking warfarin for occlusive vascular disease and we discuss the treatment.

Symptomatic Tarlov Cyst Following Spontaneous Subarachnoid Hemorrhage

Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage.