Presentation
Back pain and lower limb weakness.
Patient Data
A large expansile intra-dural cystic mass in the spinal canal extends from L1 to L5 levels, measuring about 8.4 x 2.2 x 2.5 cm in CC, AP, and TR dimensions. The lesion returns heterogeneous high signals on T2WI and STIR sequences and low signals on T1WI with no significant post-contrast enhancement. There is intense diffusion restriction visible in the lesion.
There is no extension to the neural foramina on either side.
Edema of the conus medullaris is noted.
There is a mild enhancement in the vicinity of the proximal and distal ends of the lesion, likely congested vessels/cauda-equina roots.
Case Discussion
Considering the presence of diffusion restriction in the cystic lesion, the features are suggestive of a spinal epidermoid cyst.
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