Intramedullary dermoid cyst with relatively atypical symptoms: a case report and review of the literature

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.

Figure 1

Sagittal T1-weighted image shows a hypointense lesion with a hyperintense signal area at the lower end (arrowhead).

Figure 2

Sagittal T2-weighted axial image showing a homogenously hyperintense lesion.