30 years old male with history of low back pain and paresthesia in bilateral lower limb

30 years old male with history of low back pain and paresthesia in bilateral lower limb

30 years old male with a history of low back pain and paresthesia in bilateral lower limb

A well defined intradural T2 hyperintense (A) , T1 hypointense (B) non-enhancing (C) lesion occupying cauda equina with restriction on DWI & ADC images (D & E)

Diagnosis:
Intraspinal Epidermoid cyst

Discussion:

  • Intraspinal epidermoid cysts represent less than 1% of intraspinal tumors in adults, with a higher incidence in children. They are usually extramedullary but rarely can be intramedullary, and can be congenital or acquired
  • Congenital epidermoids often have associated epidermal defects, such as spina bifida and hemivertebrae, whereas acquired lesions lack osseous abnormalities. Approximately 40% of intraspinal epidermoid cysts are acquired and are considered to be a late complication of lumbar puncture.
  • Clinically intraspinal epidermoid cysts may be asymptomatic and discovered incidentally. If symptomatic, motor disturbances, pain, sensory disturbances, and bowel or bladder dysfunction may be present.
  • Key Diagnostic Features: Although the signal intensity of epidermoid cyst varies, it is typically iso- or slightly hyperintense compared with that of CSF on all sequences, shows no contrast enhancement, and restricts on DWI.
  • DDx: Arachnoid cyst, Dermoid cyst, Cystic neoplasm
  • Treatment: Surgical excision

Dr. Sriram Patwari
MD, PDCC (Neuroradiology)
Consultant Radiology, Co-lead Neuroradiology
Manipal Hospitals Radiology Group