Forty-five days after a substantial physical effort, a 14-year-old boy developed low back pain and severe waddling-steppage gait (video 1). Deep tendon reflexes were abolished in the lower limbs and plantar responses inapparent. A spinal MRI depicted a cyst extending from T5 to S2 (figure). A complete thoracic cyst resection (video 2) and a lumbar cyst peritoneal shunt were performed. The pathologic specimen examination was conclusive for arachnoid cyst. After 4 months, the gait was normal (video 3). Speculatively, the physical effort accentuated a ball valve phenomenon1 in a preexisting asymptomatic idiopathic arachnoid cyst.
Figure Sagital T1-weighted gadolinium MRI of the thoracic (A) and lumbosacral (B) spinal cord showing a large, multi-lobulated posterior subarachnoid cyst extending from T5 to S2 and displacing the spine anteriorly
Footnotes
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