Case report
Ganglion cyst of the cervical spine presenting with Brown-Sequard syndrome

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Abstract

Ganglion cysts of the spine are uncommon. They occur mostly in the dorsolateral trunk and arise with the greatest frequency in the lumbar spine. However, they are rarely symptomatic. We report a rare case of a patient with a ganglion cyst of the lower cervical spine presenting with acute Brown-Sequard syndrome. The patient had no history of trauma. Magnetic resonance imaging of the cervical spine showed a cystic lesion connecting to the synovial joint C6–7 and compressing the posterior aspect of the spinal cord. The patient underwent emergent C6–7 laminectomy with total removal of the cyst. Neurological function recovered completely 4 months after operation. Ganglion cysts should be considered in the differential diagnosis of an extradural mass of the cervical spine. Magnetic resonance imaging provides a rapid and correct diagnosis, and laminectomy with removal of the cyst results in good neurological recovery.

Introduction

Synovial or ganglion cysts of the spine are uncommon and originate from the articular facet joint or yellow ligament.1 Both synovial and ganglion cysts are considered an extrusion of the synovium through a capsular defect from a degenerative or unstable facet joint.2 These intraspinal cysts have been described as occurring mainly in the lumbar region.[3], [4] Synovial cysts of the cervical spine are rare. To our knowledge, only 27 cases of synovial cyst in the cervical spine have been reported in the English-language literature.5 These lesions are seldom symptomatic, but do sometimes cause compression associated with neurological symptoms and signs.[1], [6], [7]

Brown-Sequard syndrome, first reported by Brown-Sequard in 1846, is characterized by ipsilateral hemiplegia and contralateral hemianalgesia. It is observed in association with trauma, spinal tumors, degenerative disease, infection, haemorrhage and miscellaneous causes.[8], [9], [10], [11] There is no previous report of a patient with a ganglion cyst presenting with Brown-Sequard syndrome in the English literature. Here we report one such rare case. The cause of the unusual signs and symptoms, diagnosis, and treatment of this disease are discussed.

Section snippets

Case report

The following is reported with the informed consent of the patient. He is a 58-year-old man who experienced sudden onset of weakness of the left side, and was immediately brought to our emergency department for further evaluation and treatment. The patient had a history of chronic renal failure, hyperuricemia and hypertensive cardiovascular disease, and had been treated with quinapril, aspirin, colchicine and allopurinol for many years, but there was no history of trauma. Neurological

Discussion

Intraspinal extradural ganglion cysts and synovial cysts both originate from the facet joint.1 The two lesions have similar clinical and radiographic features.6 The major difference between the two cysts is their histopathological features. Synovial cysts consist of synovial lining and clear fluid, whereas ganglion cysts are composed of a connective tissue capsule and gelatinous and highly viscous fluid without a specific lining.[1], [6] The pathogenesis of these lesions remains controversial.

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