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NEUROIMAGE
Year : 2010  |  Volume : 58  |  Issue : 4  |  Page : 678-679

Ruptured spinal dermoid with central canal and intraventricular extension


Departments of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Acceptance09-Oct-2009
Date of Web Publication24-Aug-2010

Correspondence Address:
Sameer Vyas
Senior Research Associate, Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.68700

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How to cite this article:
Vyas S, Giragani S, Singh P, Khandelwal N. Ruptured spinal dermoid with central canal and intraventricular extension. Neurol India 2010;58:678-9

How to cite this URL:
Vyas S, Giragani S, Singh P, Khandelwal N. Ruptured spinal dermoid with central canal and intraventricular extension. Neurol India [serial online] 2010 [cited 2019 Aug 23];58:678-9. Available from: http://www.neurologyindia.com/text.asp?2010/58/4/678/68700


A 35-year-old male presented with history of pain and weakness of both the lower limbs 15 years back. Magnetic resonance imaging (MRI) done at that time showed dermoid in the lumbosacral region. Dubulking surgery was performed 7 years back. For the last 4 years, he developed numbness and weakness of all the four limbs with bladder and bowel incontinence. On examination, he had wasting and weakness of leg muscles and sensory loss in the radicular distribution in the lower limbs with absent deep tendon reflexes in the lower limbs. Bulbocavernous reflex was absent. The MRI of the whole spine revealed presence of heterogeneous dermoid at the conus medullaris with central canal and cranial extension of the fat droplets [Figure 1] and [Figure 2].
Figure 1 :Sagittal whole spine T1 (a) and T2 (b) images showing lobulated conus and cauda equine mass with multiple hyperintensities extending along the central canal till the cervicomedullary junction. In addition similar signal intensity focus is seen in fourth ventricle (arrow)

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Figure 2 :Axial T1 (a) and (b) T2W images showing T1 and T2 hyperintense foci in frontal horns of bilateral lateral ventricles suggestive of fat droplets

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Dermoids are rare congenital tumors comprising 1.1% of the intraspinal tumors, with lumbosacral region and cauda equine being the common sites. [1],[2] Although they are benign, they can grow in size due to accumulation of secretions and may rupture. They may rupture spontaneously or following surgery or trauma. The resultant rupture can be into the subarachnoid space, central canal and ventricles. [2],[3] These can be asymptomatic or cause symptoms secondary to obstructive hydrocephalus or chemical meningitis. With the frequent use of MRI, spontaneous dermoid rupture is now diagnosed with confidence even in asymptomatic patients. [3] MRI is the most important radiologic modality to diagnose the presence and distribution of ruptured tumor content into the subarachnoidal space or into the central spinal canal, as in this patient, and also to detect complications such as hydrocephalus or meningitis after rupture and for follow-up after surgery. [1],[2],[3]



 
  References Top

1.Barsi P, Kenez J, Varallyay G, Gergely L. Unusual origin of free subarachnoid fat drops: A ruptured spinal dermoid tumour. Neuroradiology 1992;34:343-4.  Back to cited text no. 1      
2.Cha JG, Paik SH, Park JS, Park SJ, Kim DH, Lee HK. Ruptured spinal dermoid cyst with disseminated intracranial fat droplets. Br J Radiol 2006;7:167-9.  Back to cited text no. 2      
3.Garg A, Gupta V, Gaikwad S, Deol P, Mishra NK, Suri A. Isolated central canal rupture of spinal dermoid: Report of two cases. Australas Radiol 2003;47:194-7.  Back to cited text no. 3      


    Figures

  [Figure 1], [Figure 2]

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