Intramedullary epidermoid cyst presenting with abnormal urological manifestations
Study design: Report of an epidermoid cyst with intramedullary localization.
Objective: To describe an atypical presentation of intramedullary epidermoid cyst.
Summary of background data: Intramedullary epidermoid cysts are rare entities with a marked variability in the clinical presentation, essentially of neurological pertinence.
Methods: Case report of a spinal epidermoid cyst in a 13-year-old girl presenting with urological symptoms: she had a 12-month history of recurrent low urinary tract infections, urinary frequency and nocturnal enuresis. A urodynamic evaluation was performed and showed the presence of involuntary bladder contractions with detrusor instability and low bladder compliance. Magnetic resonance imaging of the spine demonstrated an intramedullary lesion of the dorsal spinal cord.
Results: The mass was excised and 6 months after surgical excision, urological manifestations improved with decreased detrusor hyper-reflexia, increased bladder capacity and compliance and no later report of urinary tract infections.
Conclusions: In our patient, unusual clinical manifestations of the tumor have delayed the diagnosis, but its complete removal has led to remission of symptoms. Detailed neurological examination and investigations are indicatedin patients with clinical and urodynamic features, suggestive of neuropathic bladder.
Introduction
Epidermoid cyst in the spinal cord is a rare condition, constituting only 0.6–1.1% of all spinal tumors. The majority of spinal epidermoid cysts are subdural and extramedullary, while intramedullary localization is very rare.
Intramedullary epidermoid cyst is common in lumbosacral and thoracic regions; two frequent localizations are T4–T6 andT 11–T12, while only three cases have been reported with cervical cord involvement. The symptoms at presentation of epidermoid cysts in the lower thoracic and upper lumbar regions are usually neurologic, such as progressive paraparesis and motor-sensory complaints; sphincter troubles may occur later.
We report a case of a 13-year-old patient with an intramedullary epidermoid cyst presenting with urological
manifestations.
Case report
This 13-year-old girl was referred to our hospital with a 12-month history of recurrent low urinary tract infections (UTI), urinary frequency and nocturnal enuresis. The first diagnostic evaluation had included renal filling phase of the cystometric curve, with worsening ultrasonography and voiding cystouretrography that were normal. In addition, urological studies had been completed with cystometrography in order to evaluate compliance, involuntary detrusor contractions, bladder volume and desire to void. Urodynamic findings had shown detrusor instability, defined as presence of uninhibited contractions of the bladder muscle at pressure more than 15 cm/H2O, occurring during the bladder compliance. Urological symptoms persisted despite antibiotic and anticholinergic treatment with oxybutynin chloride (0.1 mg/kg/die).
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