Intramedullary Dermoid Cyst With Relatively Atypical Symptoms

A Case Report and Review of the Literature

Maryam Sanaullah; Sidra Mumtaz; Akhtar Amin Memon; Abdul Sattar Mohammad Hashim; Sanaullah Bashir

Disclosures

J Med Case Reports. 2013;7(104) 

In This Article

Abstract and Introduction

Abstract

Background: Intraspinal dermoid cysts are rare and benign tumors that occur primarily due to the defective closure of the neural tube, an ectodermal derivative, during the process of development. They are slow-growing tumors manifesting in the second and third decades of life.

Case presentation: We present here a case of a 14-year-old Sindhi boy with a six-month history of paraparesis of the lower limbs and a progressive loss of power of grade 3/5, and hypoesthesia in the L4/L5 dermatomes of his right lower limb. A plain magnetic resonance imaging scan revealed a well-demarcated intraspinal intramedullary cyst containing an abscess at the level of T12 and L1 causing localized cord compression, which was producing the symptoms. Near total excision of the cyst was successfully performed and was sent for biopsy, which revealed keratinocytes and keratin flakes. With one month of follow-up, along with physiotherapeutic management, the patient gradually improved and was able to walk without support.

Conclusions: Critical evaluation of every case with aggravating symptoms should be carried out, and neurological and radiological examinations should be conducted to ensure the well-being of patients.

Introduction

Amid the numerous defects and deviations from normal development patterns, very few exist as uncommon in medical history as the dermoid cyst. There is no exact knowledge of the prevalence of intracranial dermoid cysts, however, the few studies reported to date propose it to be 0.3 percent.[1] Only a few cases have been reported in the literature.[2–4] Patients with these cysts usually have an extended history of symptoms, on average about 8.5 years between the appearance of symptoms and diagnosis.[5,6]

Dermoid cysts can appear subdurally, extramedullary or intramedullary, with intramedullary presentations being relatively rare.[7] Presented here is a case of an intradural intramedullary, space-occupying cyst at the conus medullaris level in a 14-year-old boy together with the magnetic resonance imaging (MRI) and histopathological findings and relevant scientific literature review.

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