Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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June 29, 2015
Intraspinal Epidermoid Cyst
- Background: Intraspinal epidermoid cysts represent greater than 1% of intraspinal tumors in adults (more common in children). They are usually extramedullary, but can also be intramedullary. Congenital epidermoids may have associated spinal anomalies (eg, spina bifida, hemivertebrae). Approximately 40% of intraspinal epidermoid cysts are acquired, possibly as a late complication of lumbar puncture.
- Clinical Information: Often asymptomatic and discovered incidentally. If symptomatic, motor/sensory disturbances, pain, or bowel/bladder dysfunction may be present.
- Key Diagnostic Features:
- Typically iso- or slightly hyperintense to CSF signal on all sequences, without contrast enhancement.
- Restricted diffusion is a key differentiating features.
- DDx:
- Arachnoid cyst
- Dermoid cyst
- Neurenteric cyst
- Cystic neoplasm
- Treatment: Conservative management, surgical excision