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Case Reports
. 2019 Feb 27;12(2):e227666.
doi: 10.1136/bcr-2018-227666.

Unexplained paraparesis following subarachnoid haemorrhage

Morgan J Bressington  1 , Gulam Zilani  1 , Dmitri Shastin  1   2 , Chirag Patel  1
Affiliations
Case Reports

Unexplained paraparesis following subarachnoid haemorrhage

Morgan J Bressington et al. BMJ Case Rep. .

Abstract

Spinal arachnoid cysts (SAC) are rare in isolation and the exact aetiology is still debated. Primary (congenital) cysts are caused by structural abnormalities in the arachnoid layer and largely affect the thoracic region. Secondary cysts are induced by a multitude of factors, infection, trauma or iatrogenic response, and can affect any level of the spinal cord. While subarachnoid haemorrhage (SAH) is a relatively common condition with significant repercussions, it is extremely uncommonly associated with SAC. When present, it may develop in the months and years after the original bleed, giving rise to new neurological symptoms. Prompt treatment is needed to halt or reverse the worsening of symptoms and questions are still being asked about how best to approach this condition. A 42-year-old man presented with chronic back pain, severe worsening ataxia and numbness below the umbilicus, 7 months after treatment for a World Federation of Neurosurgical Societies grade five (WFNS V) SAH. Imaging revealed a SAC extending from T12 to L4 and causing thecal compression. This was treated with a L3 laminectomy andmarsupialisation. An improvement in neurological function was observed at 6 months. Aetiology of the SAC and its association with SAH are discussed and a review of the relevant literature is provided.

Keywords: spinal cord; stroke.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
A sagittal lumbosacral T2-weighted MRI showing intradural, extramedullary lesion extending from T12 to L4 (yellow arrowheads) with associated thecal compression (yellow arrow). The lesion follows CSF signal in all MRI sequences (others not shown) and is strongly suggestive of a spinal cyst.
Figure 2
Figure 2
A follow-up postoperative scan at 6 months. Appearances show decreased compression of thecal sac (yellow arrow) after cyst decompression.
See this image and copyright information in PMC

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