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Images in Neurology
January 2000

Craniospinal Intradural Arachnoid Cyst

Arch Neurol. 2000;57(1):128. doi:10.1001/archneur.57.1.128

Arachnoid cysts are intra-arachnoid collections of cerebrospinal fluid (CSF) that produce neurological symptoms either by compressing the adjacent neural tissue or by obstructing cerebrospinal fluid flow.1 Most of these cysts are congenital. Consequently, about 75% of those causing symptoms are diagnosed in young children. Meningitis, trauma, and hemorrhage are considered to be causative or contributing factors in the genesis of acquired arachnoid cysts.2 The cysts located at the craniospinal junction are very rare.2 We describe a 48-year-old man with a gait disorder and a 30-year history of frequent falls. He had tuberculous meningitis in the second decade of life. No other medical antecedents were recorded. Neurological examination revealed a spastic paraparesis with brisk tendon reflexes and a bilateral Babinski sign. The rest of the findings were normal, and no sensory level was found. A craniocervical magnetic resonance imaging scan (Figure 1) showed a cyst whose contents had cerebrospinal fluid signal characteristics. The cyst was situated in the craniocervical junction, compressing the spinal cord at the cervical level. A small cervical syrinx was also found. An occipital craniotomy and a C1-C2 laminectomy were performed and revealed a large calcified cyst. The cyst was not removed, and patient's symptoms markedly improved after the surgery.

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