ABSTRACT
Iophendylate (Myodil) was a popular oil-based contrast agent used until late 1980s for myelography, ventriculography and cisternography. Although several long-term sequelae have been reported in literature, they are extremely rare. We report a rare occurrence of symptomatic dorsal arachnoid cyst 40 years after Myodil myelography.
Subject(s)
Arachnoid Cysts/chemically induced , Arachnoiditis/chemically induced , Contrast Media/adverse effects , Iophendylate/adverse effects , Myelography/adverse effects , Syringomyelia/chemically induced , Arachnoid Cysts/surgery , Arachnoiditis/diagnosis , Humans , Male , Middle Aged , Myelography/methods , Syringomyelia/diagnosis , Syringomyelia/surgery , Treatment OutcomeABSTRACT
Spinal arachnoiditis can rarely occur following irritation from foreign body substances, including certain oil based contrast agents used for myelography. We describe a patient with thoracic arachnoiditis, arachnoid cyst and syringomyelia, 30 years following a myelogram with Myodil. A 62-year-old female presented with chronic thoraco-lumbar back pain, a spastic paraparesis and sphincter disturbance. She had undergone a myelogram with Myodil, 30 years previously for investigation of back pain. A MRI scan revealed evidence of arachnoiditis, thoracic syringomyelia (T6-T8) and an anteriorly placed, extramedullary, arachnoid cyst at T10-T12, compressing the cord. At surgery, T7-T10 thoracic laminectomies were carried out and syringo- and cysto-subarachnoid shunts were inserted. At 12 months follow-up, the sphincter disturbance, lower limb weakness and mobility problems had almost resolved. Although, the use of oil based contrast agents such as Myodil has been discontinued, the present case illustrates some of the rare sequelae of its use, manifesting decades later. Aggressive surgical intervention produced symptomatic benefit.
Subject(s)
Arachnoid Cysts/chemically induced , Arachnoiditis/chemically induced , Contrast Media/adverse effects , Iophendylate/adverse effects , Syringomyelia/chemically induced , Arachnoid Cysts/complications , Arachnoid Cysts/diagnosis , Arachnoid Cysts/surgery , Arachnoiditis/diagnosis , Arachnoiditis/surgery , Female , Follow-Up Studies , Humans , Low Back Pain/diagnosis , Magnetic Resonance Imaging , Medical Records , Middle Aged , Neurosurgical Procedures , Spinal Cord Compression/diagnosis , Spinal Cord Compression/etiology , Syringomyelia/diagnosis , Syringomyelia/surgery , Thoracic Vertebrae , Time FactorsABSTRACT
A case is reported of a 59-year-old man with a spinal arachnoid cyst accompanied by spinal arachnoiditis. The patient developed symptoms after treatment for a ruptured vertebral artery aneurysm, in which fibrin glue was used for reconstruction of the suboccipital bone defect. It is believed that the fibrin glue may have played a role in forming the arachnoid cyst. The authors urge the readers to keep in mind the possibility of subclinical spinal arachnoiditis in the patients with aneurysmal subarachnoid hemorrhage and suggest that care should be taken to avoid any possible adverse effect of fibrin glue.
Subject(s)
Aneurysm, Ruptured/surgery , Arachnoid Cysts/chemically induced , Fibrin Tissue Adhesive/adverse effects , Intracranial Aneurysm/surgery , Spinal Cord Diseases/chemically induced , Vertebral Artery , Administration, Topical , Aneurysm, Ruptured/complications , Arachnoiditis/chemically induced , Chronic Disease , Fibrin Tissue Adhesive/administration & dosage , Humans , Intracranial Aneurysm/complications , Male , Middle Aged , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/surgeryABSTRACT
A case of a arachnoidal cyst with intracystic bleeding and subdural haematoma is reported. The association of an arachnoidal cyst in the middle cranial fossa with a subdural haematoma or intracystic bleeding is emphasised. The diagnosis of such lesions, the nature of the pathology and therapy are discussed.
