Samina Qazi, Khaleeq uz Zaman.
Neurenteric Cysts: Rare Cause of Spinal and Radicular Pain.
J Coll Physicians Surg Pak Jan ;11(8):511-3.

Neurenteric cyst is a rare condition and usually gets diagnosed only when patients are investigated for neurological deficit. It can present with acute excruciating local pain mimicking spinal tuberculosis. It can also present with insidious low intensity pain mimicking chronic backache due to spondylosis. We report two cases of neurenteric cysts operated in our center over the past ten years. One patient presented with severe neck pain while other with backache and dysesthesia of the left leg. Both of them got diagnosed when they developed quadriparesis and paraparesis respectively. Both of them after excision of the cyst had excellent recovery. These cases are reported here to highlight the presentation of neurenteric cyst with pain.

CASE-I : An 8 years old girl was presented with severe neck pain. On her initial presentation she did not have any neurological deficit. Because of the severity of pain, tuberculosis of the spine was suspected and MRI was done which showed well circumscribed hypodense intradural lesion on T-I weighted image at C4-5 level. It was not possible to decide on MRI whether it was lying in an intramedullary or extramedullary location. She was advised surgery but the parents declined. She presented 3 months later with quadriparesis. Cervical laminectomy was performed and an intramedullary cyst was encountered containing yellowish fluid, which was aspirated and complete excision of the cyst was done. Histopathology report showed a cyst wall lined by cuboidal epithelium on collagen fibrils, diagnostic of neurenteric cyst.

CASE-II: A 38 years old lady was presented with two weeks history of progressive spastic paraparesis. She had a 2 years history of backache, pain and dysesthesia of the left leg, which was resistant to treatment. She was advised CT myelogram which revealed a well circumscribed intradural hypodense lesion at T7-8 level, more on left side as shown in figure 1. Dorsal laminectomy was done and an intramedullary cyst with extramedullary extension containing xanthochromic fluid encountered, was excised completely. Patient had marked neurological improvement postoperatively, however, dysesthesia persisted for four months after surgery. Histopathology revealed neurenteric cyst.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com