Answer for BIR CoW 28 Oct 2018
Spinal arachnoid cyst
Findings
well defined loculated CSF intensity cystic lesion noted in intradural, extramedullary D11-L1 vertebral level extending into right D11-D12, D12-L1 neural foramina causing D12 & L1 nerve root compression.
Discussion
Nabor’s classification for spinal meningeal Cysts, Extramedullary cysts of the spinal canal - three main groups. The first group- meningeal cysts, can be further Classified into subgroups as Type 1- extradural meningeal cysts that contain no neural tissue Type 2-extradural meningeal cysts that contain neural tissue Type 3 -intradural meningeal cysts. The second main group- nonmeningeal epidural cysts, Nonneoplastic lesions Juxtaarticular cysts, Pigmented villonodular synovitis, and, Herniated disks, Neoplastic lesions Dermoids, Cystic nerve sheath lesions, Metastases The third group of spinal meningeal cysts - neurenteric cysts Meningeal cysts Type 1–extradural meningeal cysts containing no neural tissue Type 1A- extradural arachnoid cysts and Type 1B- sacral meningoceles Type 1A cysts- Arise from the herniation of the arachnoid through congenital or acquired dural defects The cysts begin as diverticula and subsequently enlarge, possibly because of a valvelike mechanism Postural changes and valsalva’s maneuver may produce symptoms. Type 1B The origin and pathogenesis of sacral meningoceles are uncertain Association of the entity with other spinal anomalies suggests a congenital origin. Type 2—extradural meningeal cysts containing Neural tissue These extradural meningeal cysts contain either nerve roots (i.E., Perineurial cysts or tarlov cysts) or herniated spinal cord . Cysts containing spinal nerve root fibers typically arise in the perineurial space between the endoneurium (continuous with the pia mater) and the perineurium (derived from the arachnoid membrane) Type 3—intradural meningeal cysts Intradural meningeal cysts consist of loculations of the arachnoid that may cause symptomatic compressive myelopathy. Most of the cysts communicate with the subarachnoid space through a narrow neck.
Reference Osborn AJR:178, January 2002
Findings
well defined loculated CSF intensity cystic lesion noted in intradural, extramedullary D11-L1 vertebral level extending into right D11-D12, D12-L1 neural foramina causing D12 & L1 nerve root compression.
Discussion
Nabor’s classification for spinal meningeal Cysts, Extramedullary cysts of the spinal canal - three main groups. The first group- meningeal cysts, can be further Classified into subgroups as Type 1- extradural meningeal cysts that contain no neural tissue Type 2-extradural meningeal cysts that contain neural tissue Type 3 -intradural meningeal cysts. The second main group- nonmeningeal epidural cysts, Nonneoplastic lesions Juxtaarticular cysts, Pigmented villonodular synovitis, and, Herniated disks, Neoplastic lesions Dermoids, Cystic nerve sheath lesions, Metastases The third group of spinal meningeal cysts - neurenteric cysts Meningeal cysts Type 1–extradural meningeal cysts containing no neural tissue Type 1A- extradural arachnoid cysts and Type 1B- sacral meningoceles Type 1A cysts- Arise from the herniation of the arachnoid through congenital or acquired dural defects The cysts begin as diverticula and subsequently enlarge, possibly because of a valvelike mechanism Postural changes and valsalva’s maneuver may produce symptoms. Type 1B The origin and pathogenesis of sacral meningoceles are uncertain Association of the entity with other spinal anomalies suggests a congenital origin. Type 2—extradural meningeal cysts containing Neural tissue These extradural meningeal cysts contain either nerve roots (i.E., Perineurial cysts or tarlov cysts) or herniated spinal cord . Cysts containing spinal nerve root fibers typically arise in the perineurial space between the endoneurium (continuous with the pia mater) and the perineurium (derived from the arachnoid membrane) Type 3—intradural meningeal cysts Intradural meningeal cysts consist of loculations of the arachnoid that may cause symptomatic compressive myelopathy. Most of the cysts communicate with the subarachnoid space through a narrow neck.
Reference Osborn AJR:178, January 2002
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!