Herrington Julie, Batthish Michelle, Takrouri Heba, Yarascavitch Blake, Gross Anita
School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada.
J Man Manip Ther. 2024 Jun;32(3):343-351. doi: 10.1080/10669817.2024.2334103. Epub 2024 Apr 2.
Pediatric intraspinal epidermoid cysts are rare with potential to cause life-altering outcomes if not addressed. Reports to date describe symptomatic presentations including loss of bladder or bowel function and motor and sensory losses. This case report identifies the diagnostic challenge of an asymptomatic intraspinal epidermoid cyst in the cauda equina region presenting in a 7-year-old male with juvenile idiopathic arthritis (JIA).
An advanced physiotherapist practitioner assessed and diagnosed a previously healthy 7-year-old-male of South Asian descent with JIA based on persistent knee joint effusions. Complicating factors delayed the investigation of abnormal functional movement patterns, spinal and hip rigidity and severe restriction of straight leg raise, all atypical for JIA. Further delaying the diagnosis was the lack of subjective complaints including no pain, no reported functional deficits, and no neurologic symptoms. A spinal MRI investigation 10-months from initial appointment identified intraspinal epidermoid cysts occupying the cauda equina region requiring urgent referral to neurosurgery.
Clinical characteristics and pattern recognition are essential for diagnosing spinal conditions in pediatric populations. Diagnostic challenges present in this case included co-morbidity (JIA), a severe adverse reaction to treatment, a lack of subjective complaints and a very low prevalence of intraspinal epidermoid cysts.
Early signs of pediatric asymptomatic intraspinal epidermoid cysts included abnormal functional movement patterns, rigidity of spine, severely limited straight leg raise and hip flexion without pain. Advanced physiotherapist practitioners can be integral to pediatric rheumatology teams considering their basic knowledge in musculoskeletal examination and functional mobility assessment when identifying rare spinal conditions that present within the complex context of rheumatic diseases.
小儿脊髓内表皮样囊肿罕见，若不治疗可能导致改变生活的后果。迄今为止的报告描述了其症状表现，包括膀胱或肠道功能丧失以及运动和感觉丧失。本病例报告确定了一名7岁患幼年特发性关节炎（JIA）的男性马尾区无症状脊髓内表皮样囊肿的诊断挑战。
一名高级物理治疗师根据持续的膝关节积液，对一名先前健康、南亚裔、患JIA的7岁男性进行了评估和诊断。复杂因素延误了对异常功能运动模式、脊柱和髋关节僵硬以及直腿抬高严重受限的调查，这些均非JIA的典型表现。进一步延误诊断的是缺乏主观症状，包括无疼痛、无功能缺陷报告以及无神经症状。初次就诊10个月后的脊髓MRI检查发现脊髓内表皮样囊肿占据马尾区，需紧急转诊至神经外科。
临床特征和模式识别对于诊断儿科患者的脊柱疾病至关重要。该病例中存在的诊断挑战包括合并症（JIA）、对治疗的严重不良反应、缺乏主观症状以及脊髓内表皮样囊肿的极低患病率。
小儿无症状脊髓内表皮样囊肿的早期迹象包括异常功能运动模式、脊柱僵硬、直腿抬高严重受限以及无痛性髋关节屈曲。考虑到高级物理治疗师在肌肉骨骼检查和功能活动评估方面的基本知识，在识别风湿性疾病复杂背景下出现的罕见脊柱疾病时，他们可以成为儿科风湿病团队的重要组成部分。
