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Tarlov cyst: Case report and review of literature

Bhagwat Prashad, Anil K Jain, and Ish K Dhammi

University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahadara, Delhi, India


We describe a case of sacral perineural cyst presenting with complaints of low back pain with neurological claudication. The patient was treated by laminectomy and excision of the cyst. Tarlov cysts (sacral perineural cysts) are nerve root cysts found most commonly in the sacral roots, arising between the covering layer of the perineurium and the endoneurium near the dorsal root ganglion. The incidence of Tarlov cysts is 5% and most of them are asymptomatic, usually detected as incidental findings on MRI. Symptomatic Tarlov cysts are extremely rare, commonly presenting as sacral or lumbar pain syndromes, sciatica or rarely as cauda equina syndrome. Tarlov cysts should be considered in the differential diagnosis of patients presenting with these complaints.

Tarlov Cyst And CSF Leak – A Case Report And Review Of Literature

Suresh S Pillai, Swaroop Sujath

Division Of Spine Surgery – Dept. Of Orthopedics, Baby Memorial Hospital Calicut, Kerala, India


Tarlov cyst results from congenital weakness, trauma or inflammation of the dura matched with disturbance of CSF hydrodynamics. Surgical decompression & imbrication of the cyst gives good results. CSF leak is the most common complication which can be managed with fat graft, fibrin glue, direct repair or lumbar CSF drainage.

COVID-19-Associated Myelitis Involving the Dorsal and Lateral White Matter Tracts: A Case Series and Review of the Literature

H.Y. Huang, L.M. Shah, J.S. McNally, T. Sant, T.A. Hutchins, E.D. Goldstein and M.E. Peckham.

Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, 30 North, 1900 East, 1A071, Salt Lake City, UT


SUMMARY: Coronavirus disease 2019 (COVID-19) myelitis is a rare condition, most commonly presenting with nonenhancing central expansile cord T2 signal changes. A single case report has also described longitudinal involvement of the dorsal columns. We present 5 cases of COVID-19-associated myelitis with tract-specific involvement of the dorsal and lateral columns and discuss potential pathophysiologic pathways for this unique pattern.

COVID-19–associated acute transverse myelitis: a rare entity

Uddalak Chakraborty, Atanu Chandra, Aritra Kumar Ray and Purbasha Biswas.

Internal Medicine, R G Kar Medical College and Hospital, Kolkata, India


SARS-CoV-2 has wreaked havoc globally and has claimed innumerable lives all over the world. Apart from the characteristic respiratory illness, this disease has been associated with florid extrapulmonary manifestations and complications. A 59-year-old female healthcare worker presented with features of acute-onset non-compressive myelopathy with a sensory level at T10 segment along with high-grade fever for 4 days. MRI of dorsal spine was suggestive of myelitis at T7 vertebral level. She was initiated on injectable steroids and did show some initial signs of recovery. A day later, she developed an acute-onset respiratory failure but could not be revived despite our best efforts. Her nasopharyngeal and oropharyngeal swab turned out to be positive for SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR). We hereby report a case of acute transverse myelitis with COVID-19 as a probable aetiology.

Acute Transverse Myelitis (ATM):Clinical Review of 43 Patients With COVID-19-Associated ATM and 3 Post-Vaccination ATM Serious Adverse Events With the ChAdOx1 nCoV-19 Vaccine (AZD1222)

Gustavo C. Román, Fernando Gracia, Antonio Torres, Alexis Palacios, Karla Gracia and Diógenes Harris

Department of Neurology, Neurological Institute, Houston Methodist Hospital, Houston, TX, United States

Weill Cornell College of Medicine, Cornell University, New York, NY, United States

Department of Neurology, Texas A&M University College of Medicine, Bryan, TX, United States

Neurology Service, Hospital Paitilla, Panama City, Panama

Faculty of Health Sciences, Interamerican University of Panama, Panama City, Panama

Neurology Service, Hospital Santo Tomás, Panama City, Panama

Infectious Disease Service, Hospital Santo Tomás, Panama City, Panama

Neuroradiology Service, Complejo Hospitalario Metropolitano, CSS (Caja de Seguro Social), Panama City, Panama

Interamerican University of Panama, Panama City, Panama

Neurosurgery Service, Complejo Hospitalario Metropolitano, CSS, Panama City, Panama


Introduction: Although acute transverse myelitis (ATM) is a rare neurological condition (1.34-4.6 cases per million/year) COVID-19-associated ATM cases have occurred during the pandemic.

Case-finding methods: We report a patient from Panama with SARS-CoV-2 infection complicated by ATM and present a comprehensive clinical review of 43 patients with COVID-19-associated ATM from 21 countries published from March 2020 to January 2021. In addition, 3 cases of ATM were reported as serious adverse events during the clinical trials of the COVID-19 vaccine ChAdOx1 nCoV-19 (AZD1222).

Results: All patients had typical features of ATM with acute onset of paralysis, sensory level and sphincter deficits due to spinal cord lesions demonstrated by imaging. There were 23 males (53%) and 20 females (47%) ranging from ages 21- to 73- years-old (mean age, 49 years), with two peaks at 29 and 58 years, excluding 3 pediatric cases. The main clinical manifestations were quadriplegia (58%) and paraplegia (42%). MRI reports were available in 40 patients; localized ATM lesions affected ≤3 cord segments (12 cases, 30%) at cervical (5 cases) and thoracic cord levels (7 cases); 28 cases (70%) had longitudinally-extensive ATM (LEATM) involving ≥4 spinal cord segments (cervicothoracic in 18 cases and thoracolumbar-sacral in 10 patients). Acute disseminated encephalomyelitis (ADEM) occurred in 8 patients, mainly women (67%) ranging from 27- to 64-years-old. Three ATM patients also had blindness from myeloneuritis optica (MNO) and two more also had acute motor axonal neuropathy (AMAN).

Conclusions: We found ATM to be an unexpectedly frequent neurological complication of COVID-19. Most cases (68%) had a latency of 10 days to 6 weeks that may indicate post-infectious neurological complications mediated by the host’s response to the virus. In 32% a brief latency (15 hours to 5 days) suggested a direct neurotropic effect of SARS-CoV-2. The occurrence of 3 reported ATM adverse effects among 11,636 participants in the AZD1222 vaccine trials is extremely high considering a worldwide incidence of 0.5/million COVID-19-associated ATM cases found in this report. The pathogenesis of ATM remains unknown, but it is conceivable that SARS-CoV-2 antigens –perhaps also present in the AZD1222 COVID-19 vaccine or its chimpanzee adenovirus adjuvant– may induce immune mechanisms leading to the myelitis.

Post COVID-19 transverse myelitis; a case report with review of literature

Shwan Abubakr Ahmad,a Karokh H. Salih,a Shaho Fatah Ahmed,a Fahmi H. Kakamad,a,b,c,∗ Abdulwahid M. Salh,a,d Marwan Nasih Hassan,a,c Karukh K. Mohammed,a,c Shvan H. Mohammed,c Rawezh Q. Salih,a,c and Dahat A. Husseina,c



Coronavirus disease 2019 (COVID-19) has emerged as severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). Recently, various complications have been reported. The aim of the current study is to report a rare case of transverse myelitis after recovering from COVID-19.

Case report
A 34-year-old lady, presented with inability to walk for one day duration due to the lower limb weakness. After two weeks from the recovery of COVID-19; she developed progressive intermittent leg pain, paresthesia and weakness on both sides. Brain and cervical MRI showed evidence of a short segment inflammatory enhancing lesion at upper cervical region (at C1 level). The patient was treated conservatively.

Transverse myelitis has many different causes, it occurs as an autoimmune phenomenon post-infection and vaccination, or it may result from direct infection or acquired demyelinating disease like multiple sclerosis.

Although it is a sporadic finding, SARS-CoV-2 can cause transverse myelitis. The condition responds to medical therapy.

Acute transverse myelitis in COVID-19 infection

Chian Chiang Nicholas Chow, John Magnussen, Jerome Ip and Yuen Su

Emergency Department, Hornsby Ku-ring-gai Hospital, Sydney, New South Wales, Australia

Sydney Adventist Hospital Ltd, Sydney, New South Wales, Australia


A 60-year-old man presented to hospital with bilateral lower limb weakness, urinary retention and constipation. He had been diagnosed with COVID-19 10 days prior. Clinical examination revealed global weakness, increased tone, hyperreflexia and patchy paresthesia in his lower limbs bilaterally. Preliminary blood tests performed revealed a mildly elevated C reactive protein and erythrocyte sedimentation rate but was otherwise unremarkable. MRI scan of his whole spine demonstrated hyperintense T2 signal centrally from T7 to T10, suggestive of acute transverse myelitis. A lumbar puncture showed elevated protein count but normal glucose and white blood cell count. Serological testing for other viruses was negative. His neurological symptoms improved significantly after treatment with intravenous methylprednisone. This case highlights a potential neurological complication of COVID-19 infection.

Endoscopic minimally invasive neurosurgery: emerging techniques and expanding role through an extensive review of the literature and our own experience – part II: extraendoscopic neurosurgery

Xiao Di, Alan Sui, Rodolfo Hakim, Maode Wang, Jan Peter Warnke

Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA.

Department of Neurosurgery, Paracelsus Klinik Zwickau, Germany

PMID: 22456199 DOI: 10.1159/000336019


Background/aims: The field of minimally invasive neurosurgery has grown dramatically especially in the last decades. This has been possible, in the most part, due to the advancements in technology especially in tools such as the endoscope. The contemporary classification scheme for endoscopic procedures needs to advance as well.

Methods: The present classification scheme for neuroendoscopic procedures has become confusing because it mainly describes the use of the endoscope as an assisting device to the microscope. The authors propose an update to the current classification that reflects the independence of the endoscope as a tool in minimally invasive neurosurgery.

Results: The proposed classification groups the procedures as ‘intraendoscopic’ neurosurgery or ‘extraendoscopic’ neurosurgery (XEN) in relation to the ‘axis’ of the endoscope. A review of the literature for the XEN group together with exemplary cases is presented.

Conclusion: We presented our proposed classification for the endoscope-only surgical procedures. The XEN group is expanded in this article.

Endoscopic minimally invasive neurosurgery: emerging techniques and expanding role through an extensive review of the literature and our own experience – part I: intraendoscopic neurosurgery

Xiao Di, Alan Sui, Rodolfo Hakim, Maode Wang, Jan Peter Warnke

Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA.

Department of neurosurgery, Paracelsus Klinik Zwickau, Germany

PMID: 22456186 DOI: 10.1159/000336017


Background/aims: Minimally invasive neurosurgery is a growing field, more so in recent decades. The modernization of tools, especially the endoscope, has allowed for critical improvements and crucial advancements in minimally invasive neurosurgery. The current classification scheme for endoscopic procedures needs to be updated to reflect these advancements.

Methods: Although the field of neuroendoscopy is continually evolving, the terminologies utilized to describe endoscopic procedures reflect and favor its use as mostly an assisting device complementing the microscope. Even though the classification was adequate for its time, it has become inexact and therefore confusing. We therefore propose a new classification scheme that encompasses the growing independence of endoscopic minimally invasive neurosurgery (EMIN) as well as the changing landscape within EMIN procedures.

Results: We have classified our EMIN procedures, since 2002, as either ‘intraendoscopic’ (IEN) or ‘extraendoscopic’ (XEN) in relation to the endoscope’s axis. Exemplary cases of IEN and a review of the literature are presented as well.

Conclusion: Our proposed classification scheme for solely endoscopic procedures is presented. The role of the endoscope as an independent tool is clarified.

Use of an endoscope for spinal intradural pathology

Toshiki Endo, Teiji Tominaga

Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan.

Department of Neurosurgery, Tohoku University, Graduate school of Medicine, Sendai, Miyagi, Japan.

PMID: 32656387 PMCID: PMC7340816 DOI: 10.21037/jss.2020.01.0


The endoscope has been increasingly used to treat various spinal diseases. However, the application of spinal endoscopy in an intradural lesion has been less common compared to that of an epidural counterpart. The authors reviewed existing literature describing spinal endoscopy as an aid in surgical treatment for intradural pathologies. Importantly, available literature indicated the safety and feasibility of spinal endoscopy for intradural lesions. Especially, an endoscope was utilized for intradural subarachnoid cystic lesions, tethered cord syndrome, extramedullary tumors, spinal arteriovenous malformations, and cordectomy for intractable pain. The results of this review should enhance further development and broaden application of an endoscope for various intradural pathologies.