Perineural cyst with intracystic hemorrhage following aneurysmal subarachnoid hemorrhage: A case report

Medicine
Keun-Tae Cho, Kiyeun Nam

Abstract

Most perineural cysts are asymptomatic and discovered incidentally at the time of imaging. Although enlargement of the perineural cyst (PC) through a ball-valve mechanism and resultant compression of the adjacent neural or bony structures are known to be a source of pain in PCs, the reason why asymptomatic PCs become symptomatic is unclear. The authors report a case of PC, which was presumed to become symptomatic after subarachnoid hemorrhage without enlargement of the pre-existing PC. A 47-year-old woman complained of lumbosacral pain after neck clipping for a ruptured cerebral aneurysm. Magnetic resonance imaging (MRI) revealed a PC with intracystic hemorrhage at the S2 level. In comparison with the size of the PC on computed tomography performed 3 years ago, there was no change in the size. Electrodiagnostic studies performed 6 weeks after the onset of the pain showed subacute right S2 radiculopathy. With conservative treatment, her pain gradually diminished. When the lumbosacral pain improved, follow-up MRI showed that a fluid-fluid level within the PC disappeared. Hemorrhage from the subarachnoid space, such as spontaneous aneurysmal SAH, into the pre-existing PC can cause an asymptomatic PC to become symptomatic without g...Continue Reading

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