Shimura Shigeyoshi, Saito Ryu, Yagi Takashi, Yoshioka Hideyuki, Kinouchi Hiroyuki
J Neurosurg Case Lessons. 2023 May 29;5(22). doi: 10.3171/CASE23163.
Intraspinal juxta-facet cysts of the spine are known to predominate at the lumbar level and is relatively rare at the cervical level. Most cervical spinal lesions are found incidentally, but they sometimes cause myelopathy or radiculopathy in a chronic course.
The authors present a rare case of hemorrhagic cervical juxta-facet cyst presenting with Brown-Séquard syndrome. An 86-year-old woman presented with acute-onset right hemiparesis following neck pain and was admitted to the local hospital. She was started on antithrombotic therapy with a suspected diagnosis of cerebral infarction, but quadriplegia progressed 2 days later. Cervical magnetic resonance imaging revealed an intraspinal mass at the C4-5 level and she was referred to the authors' hospital. Her neurological findings on admission revealed right Brown-Séquard syndrome. In emergency surgery, the mass was resected with a posterior approach. Pathological findings showed hemosiderin deposition and fibroblast proliferation, consistent with a juxta-facet cyst with intracystic hemorrhage. The patient recovered well and returned to an independent daily life.
Rarely, juxta-facet cyst of the cervical spine can cause acute Brown-Séquard syndrome due to intraspinal hemorrhage. In a case of hemiparesis that develops following neck pain, hemorrhagic cervical juxta-facet cyst should be taken into consideration as a differentiation.
脊柱椎管内关节突旁囊肿以腰椎节段最为常见，而在颈椎节段相对少见。多数颈椎脊柱病变是偶然发现的，但有时在慢性病程中会导致脊髓病或神经根病。
作者报告了一例罕见的伴有布朗 - 色夸综合征的出血性颈椎关节突旁囊肿病例。一名86岁女性在颈部疼痛后出现急性起病的右侧偏瘫，被收入当地医院。因疑似脑梗死开始接受抗血栓治疗，但2天后四肢瘫痪加重。颈椎磁共振成像显示C4 - 5水平椎管内有一肿块，遂转诊至作者所在医院。入院时其神经学检查结果显示为右侧布朗 - 色夸综合征。在急诊手术中，采用后路切除了肿块。病理结果显示含铁血黄素沉积和成纤维细胞增生，符合伴有囊内出血的关节突旁囊肿。患者恢复良好，回归到独立的日常生活。
颈椎关节突旁囊肿很少会因椎管内出血导致急性布朗 - 色夸综合征。对于颈部疼痛后出现偏瘫的病例，应考虑出血性颈椎关节突旁囊肿以进行鉴别诊断。
