Interactive Transcript
0:01
So, most of you know that I really
0:03
enjoy neurenteric cysts.
0:05
The reason why I enjoy neurenteric cysts is because
0:07
they, too, may be intradural or extradural,
0:10
and they may be intramedullary or extramedullary,
0:13
but they have a characteristic feature that
0:15
would lead to a specific diagnosis.
0:18
So these are, again,
0:19
developmental abnormalities with a persistence in
0:22
the connection between the central
0:24
nervous system and the GI system.
0:27
So, that's why it's called neurenteric.
0:30
And the imaging feature,
0:34
as you see in these two different patients with
0:36
neurenteric cysts that gives away the diagnosis,
0:39
is the vertebral body segmentation anomaly?
0:43
Neurenteric cysts are associated with the peculiar
0:47
appearance of the bone. In this case,
0:50
you see kind of a fused bone that is a little
0:54
bit too large for a normal vertebra.
0:56
However, they may be associated with butterfly vertebra,
1:00
or hemivertebra, or as you see here,
1:03
with congenitally fused vertebrae.
1:05
The cysts may have high protein associated
1:08
with them, so they may be bright or dark.
1:09
In this case, we have one.
1:11
This is actually a proton density-weighted scan,
1:13
so it's brighter than CSF.
1:15
This one also on a T2-weighted scan,
1:17
almost seems brighter than the CSF.
1:20
And as you can see,
1:21
there is a little meniscus here identifying it as a
1:25
intradural extramedullary lesion, displacing the
1:28
spinal cord posteriorly. However, neurenteric cysts,
1:31
as I said, can extend intramedullary,
1:35
and they can extend into the extradural space.
1:37
They may also be associated with a bronchial cyst or
1:42
a gastroenteric cyst at the same level or
1:46
at other levels above or below.
1:49
Rarely, they may be associated with
1:51
spinal dysraphic states,
1:52
and it may be a source of myelopathy
1:55
or radiculopathy.
1:56
So this is my favorite case of all time,
1:58
which I believe I've demonstrated when I was
2:01
talking about the intradural intramedullary lesion.
2:04
Why is it my favorite case of all time?
2:06
Well, it's a young adult who has a neurenteric cyst and
2:11
this neurenteric cyst shows elements
2:14
of being intradural extramedullary,
2:16
intradural intramedullary, as well as extradural.
2:19
Specific diagnosis.
2:20
You see the vertebral segmentation
2:23
abnormality here and here.
2:25
So we know with that associated finding, high
2:29
likelihood of being a neurenteric cyst.
2:32
We have a component that is clearly intramedullary.
2:36
Here's the spinal cord splaying out with the cyst
2:40
in the spinal cord and you'll notice that there is
2:43
narrowing of the cerebrospinal fluid when
2:46
it comes to the lesion.
2:48
However, we also will have a meniscus sign.
2:51
So this portion of the cyst goes from being
2:55
intradural intramedullary, to being intradural
2:58
extramedullary
3:00
behind the spinal cord with a meniscus,
3:02
except that we also see this large cyst anteriorly.
3:07
This is an extradural cyst.
3:09
This is actually the enteric portion
3:11
of the neurenteric cyst.
3:12
So this has both intradural intramedullary,
3:15
intradural extramedullary, as well as extradural
3:17
components associated with vertebral segmentation
3:20
anomaly and a fantastic case of neurenteric cyst.
3:24
You'll notice that although I'm using the term cyst,
3:26
it doesn't have CSF signal intensity.
3:28
It actually has this intermediate signal intensity.
3:31
It's filled with high protein secretions.
3:34
Got to love it.
© 2024 Medality. All Rights Reserved.