• Po-Chuan Hsieh, Shih-Ming Jung, Chieh-Tsai Wu, Jyi-Feng Chen, and Shih-Tseng Lee.
• From the Departments of *Neurosurgery and †Pathology, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Tao-Yuan, Taiwan, ROC.
• Spine. 2013 Sep 15;38(20):E1288-90.

Study DesignCase report.ObjectiveTo report a case of lumbar intraneural hemorrhagic cyst after anticoagulation therapy that caused progressive radiculopathy and cauda equina syndrome. The possible pathogenic mechanism, associated diseases, and treatment options are discussed.Summary Of Background DataVarious pathological processes can cause progressive cauda equina syndrome. However, there have been no reports of progressive cauda equina syndrome due to compression from an intraneural hemorrhagic cyst after anticoagulation therapy.MethodsA case of lumbar intradural intraneural hemorrhagic cyst with progressive cauda equina syndrome after anticoagulation therapy is presented.ResultsA 42-year-old-female patient complained at presentation of progressive bilateral lower extremity radiating pain, numbness, and urinary difficulty during the previous 2 months. Lumbar magnetic resonance imaging revealed an L1 cystic lesion with marked mass effect on the surrounding nerve roots. Complete drainage and excision of the lesion was performed, which resulted in excellent postoperative symptoms relief. Pathological examination revealed no definite neoplastic process except some nerve fibers with hemosiderin stain along the cyst wall. On the basis of a combination of intraoperative findings and pathology, an intradural intraneural hemorrhagic cyst that developed after systemic anticoagulation therapy was diagnosed.ConclusionThis is the first report of an intradural intraneural hemorrhagic cyst causing progressive cauda equina syndrome due to anticoagulation therapy. Surgical excision of the cyst is the definite treatment of choice.Level Of EvidenceN/A.

26 keywords...

hide…