Spinal extradural arachnoid cyst: an uncommon cause of thoracic spine compression

Spinal extradural arachnoid cysts are unusual causes of symptomatic spinal cord compression. They represent expanding diverticula of the subarachnoid space herniating through a dural defect into the extradural space. The pathogenesis of this entity is still unclear. We describe the clinical, neuroradiological and surgical aspects of two young patients in whom symptoms attributable to thoracic spine compression were caused by spinal extradural arachnoid cysts. The first child presented with progressive spastic paraparesis accompanied by urinary incontinence, superficial and deep sensory disturbance below the umbilical level. The second patient presented with unstable gait as a result of weakness and diminished sensation in the lower extremities. Magnetic resonance imaging showed a thoracic posterior extradural arachnoid cyst in both patients. The cyst was completely removed by posterior approach. Histological examination confirmed the diagnosis of arachnoid cyst. Neurological symptoms progressively resolved after surgical decompression. Although quite rare, the diagnosis of arachnoid cyst should be included in the differential diagnosis of intraspinal extradural cystic lesions, causing spinal cord compression. Surgery is the treatment of choice, providing good clinical outcome

Traumatic extradural haematoma in factor XI deficiency within pre-existing arachnoid cyst

Posterior fossa epidural haematoma [PFEH] is potentially a lethal complication of head injury. Factor XI [FXI] deficiency is a rare autosomal disorder that can manifest first as a bleeding or as an incidental laboratory abnormality. Reporting here a case of PFEH associated with arachnoid cyst and FXI deficiency. Twenty-year-old Moroccan man was admitted to our Neurosurgery Department due to occipital headache, vomiting, diplopia and decrease in consciousness. Seven days later the patient had a fall with occipital impact and he presented to emergency room. The neurological examination and the x-ray was normal. The patient returned to his home. Five days later the patient became symptomatic with occipital headache, vomiting, diplopia, deterioration of consciousness and nuchal stiffness. Cranial CT scan showed a huge unsuspected bilateral epidural haematoma with mass effect on the 4[th] ventricle and brainstem, with a hypodense area on left pontocerebellar angle suggestive to arachnoid cyst. Emergency preoperative blood crasis study showed prolonged activated partial thromboplastin time [aPTT] more than 120 milliseconds three times. A sub-occipital craniectomy on prone position was performed. An organized and collected "placenta like" epidural haematoma was evacuated. No source of bleeding was identified, only diffuse bleeding of dura was noted. The postoperative recovery unremarkable. The patient was alert with disappearance of symptoms and no neurological deficit was noted. The patient denied any recent self-medication. Lab study of blood erase showed prolonged aPTT. The level of FXI showed a severe deficiency of 3.1%. The level of factor XII, VIII and IX were normal. No other biologic abnormality was identified. This case confirms that FXI deficiency and arachnoid cyst are a risk factor of posterior fossa epidural haematoma

Trigonal cavernous malformation manifesting as spontaneous intraventricular haemorrhage

Intraventricular cavernomas [IVC] are rare, however, haemorrhage from a lateral ventricle cavernoma seem to be even rarer. We report a case of trigonal tumour in a 53-year-old man who presented with intraventricular haemorrhage which was initially misdiagnosed as hypertensive. Diagnosis of a tumour origin of the bleeding was suspected 3 months later on MRI. The tumour was histologically confirmed to be a cavernoma. Only ten cases of IVC with symptomatic haemorrhage have been reported. Radiological diagnosis of IVC may be difficult because of their uncommon location, their voluminous size and sometimes their ventricular bleeding. Intraventricular cavernoma should be considered in the differential diagnosis of nontraumatic intraventricular haemorrhage even in patients with chornic hypertension

Invasive skull base sphenoid mucocele

A mucocele is an epithelial lined mucus-containing sac completely filling a paranasal sinus and capable of expansion. Sphenoid mucoceles are unusual lesions, with about 130 cases reported until 2001. We present a case of a 56-year-old immunocompetent soldier with sphenoidal mucocele, documented by computed tomography and magnetic resonance imaging. The lesion was excised via translabial-transsphenoidal approach and the patient recovered completely. Early diagnosis followed by microsurgical drainage of sphenoidal mucocele and prolonged antibiotic treatment is recommended

Epidural extension of aggressive vertebral haemangioma in a child with congenital heart disease

Vertebral haemangioma is a common asymptomatic lesion in adults. Spinal cord compression is rare, especially in children. We report an unusual case of T9 vertebral haemangioma with extradural extension revealed by a thoracic spinal cord compression in a 10-year-old boy with congenital heart disease. The tumour was studied with plain radiography, computed tomography and magnetic resonance imaging. The occurrence of aggressive vertebral haemangiomas in paediatric age group is discussed

Brown-Sequard syndrome caused by cervical disc herniation

Cervical disc herniation can be a cause of neurological symptoms but rarely Brown-Sequard syndrome. This syndrome is most commonly observed in association with spinal cord injury, tumoural disease or herniation of the spinal cord. Cervical disc herniation manifesting as a hemicord syndrome is a rare clinical finding. We report two patients, aged 45 and 52 years old, presenting with a unilateral right-sided hemiparesis with associated controlateral sensory findings at the T2 dermatome level. Magnetic resonance imaging demonstrated an isolated cervical disc herniation with marked spinal cord compression at C4/C5 and C5/C6 level respectively. Surgical treatment was performed by an anterior cervical discectomy with intersomatic arthrodesis in both cases. After surgery, there was a rapid improvement in motor symptoms and signs, however sensory functions required more recovery time. The previous 19 published cases were analyzed

Cavernous haemangioma of the frontal bone

A 28-year-old female presented with a progressive right frontal mass. CT scan and plain films showed an osteolytic lesion in the right frontal bone. Surgery consisted of total resection of the lesion and cranioplasty. The postoperative source was uneventful. Histological examination revealed a cavernous haemangioma of the diploe. In view of this observation and the literature review, aetiology, clinical, radiological and therapeutic aspect of this rare entity are discussed

Cerebral infection by candida albicans

We present a case of cerebral infection by candida albicans in a previously healthy 64-year-old man who had symptoms indicative of raised intracranial pressure without fever. Computed tomography scan and magnetic resonance imaging revealed multiple cerebral granulomas. Diagnosis was made after stereotactic biopsy. The patient's symptoms improved progressively with decrease in the size of lesions after antifungal therapy. No lesions were detected outside the central nervous system. However, he died 3 weeks later from pulmonary embolism. Candida albicans of the central nervous system is uncommon and occurs rarely in immunocompetent patients. As the neurologic sings and symptoms are vague, most cases of cerebral candidiasis are diagnosed just before death or during postmortem study. We have reviewed the main clinico-pathologic features of neurocandidiasis