Yamagami Keitaro, Shono Tadahisa, Iihara Koji
Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Fukuoka, Japan.
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan.
NMC Case Rep J. 2019 Mar 21;6(2):57-60. doi: 10.2176/nmccrj.cr.2018-0242. eCollection 2019 Apr.
The origin and pathogenesis of perineurial cysts remain unclear. Here, we report a rare case of multiple sacral perineurial cysts presented symptoms triggered by nonaneurysmal perimesencephalic subarachnoid hemorrhage (SAH). A 48-year-old male presented with a severe headache of sudden onset. Brain computed tomography revealed a SAH in the basal cistern; however, no abnormal vascular lesion was detected. Four days after the onset of the SAH, he suffered from left buttock pain, followed by urinary dysfunction and paresthesia in the left S2 and S3 dermatomes. Magnetic resonance (MR) imaging demonstrated multiple cystic lesions at the left S1 and bilateral S2 sacral roots. The two cysts at the S2 level exhibited high signal intensity on both T- and T-weighted images, suggesting the content of the cysts included a hematoma. He was treated with intravenous injections of steroids, and the symptoms recovered completely within 2 months. Follow-up MR imaging revealed remarkable shrinkage of the cysts. Sacral perineurial cysts should be listed in the differential diagnosis if the patient suffers from low back pain or sacral radiculopathy after the onset of SAH.
神经束膜囊肿的起源和发病机制尚不清楚。在此，我们报告一例罕见的多发性骶部神经束膜囊肿病例，其症状由非动脉瘤性中脑周围蛛网膜下腔出血（SAH）引发。一名48岁男性突发剧烈头痛。脑部计算机断层扫描显示基底池有SAH；然而，未检测到异常血管病变。SAH发病4天后，他出现左臀部疼痛，随后出现排尿功能障碍以及左侧S2和S3皮节感觉异常。磁共振（MR）成像显示左侧S1和双侧S2骶神经根处有多个囊性病变。S2水平的两个囊肿在T加权和T2加权图像上均表现为高信号强度，提示囊肿内容物包括血肿。他接受了类固醇静脉注射治疗，症状在2个月内完全恢复。随访MR成像显示囊肿明显缩小。如果患者在SAH发作后出现腰痛或骶神经根病，应将骶部神经束膜囊肿列入鉴别诊断。
