Intradural neurenteric cyst of the cervical spine

A 60-year-old man presented with an intradural extramedullary neurenteric cyst of the cervical spinal cord. He had acute neurological deterioration in the form of quadriparesis and urinary incontinence. The patient had a history of paraneoplstic myasthenia 3 years prior to this admission. The clinical, radiological, and surgical findings are discussed together with a brief critical review of the literature. The patient had no other association anomalies. The cyst was removed totally with good neurological recovery. The clinical presentation was rather atypical for neurenteric cyst. Neurenteric cyst should be considered in the differential diagnosis of an intradural mass lesion regardless of the age, clinical presentation or location of the lesion

Cystic meningioma

Cystic meningiomas are uncommon tumours. Computed tomography scan and conventional magnetic resonance imaging may not differentiate those lesions form other tumours that are more frequently associated with cystic or necrotic changes; like gliomas or metastases. We are reporting 2 cases of cystic meningiomas in which the diagnosis was not suspected preoperatively because of short clinical history and rapid neurological deterioration. In addition; the cystic appearance of the tumours on imaging studies further confused accurate diagnosis. Although some authors believe that haemorrhage is rare in cases of meningioma, one of our cases was associated with haemorrhage and was proven to be a WHO Grade II meningioma. Because total resection is usually the goal in meningioma surgery, the help of a neruopathologist is important to establish the diagnosis during surgery

Dandy-walker malformation associated with syringomyelia: an unusual presentation

We are reporting a patients with a Dandy-Walker malformation who underwent insertion of a cysto-peritoneal shunt as a neonate. At the age of 17, she presented with difficulty in walking and black-out attacks for 6 months before she was rushed to the hospital in a coma. Following an urgent CT scan, the shunt was revised and was found to be partially obstructed by omentum. After recovery, the patients demonstrated newly developed cerebellar and pyramidal signs. MRI showed evidence of cervical syringomyelia with no brain stem involvement. A second MRI carried out 2 weeks after shunt revision, showed collapse of the syringomyelia that correlated well with the patients clinical improvement. In addition to the rare association of Dandy-Walker malformation and syringomyelia, this case also demonstracts an unusual presentation of shunt malfunction. Revision of the shunt resulted in both clinical and radiological improvement. We believe that cerebrospinal fluid shunting should be the initial step in the management of those cases