Presentation
Headache and neck pain.
Patient Data
Marked chronic supratentorial hydrocephalus with two small webs seen at the lower segment of the aqueduct of Sylvius. No CSF flow through the aqueduct of Sylvius on the cine images.
Dorsal dermal sinus tract extends from the skin surface to the cervical spinal cord opposite C2 via the widened interspinous space, the cervical spinal cord opposite C2 shows posterior distortion with posterior tenting. An associated superficial cystic lesion is noted likely epidermoid cyst. The sinus tract show fluid signal and thick wall with intense post contrast enhancement. Incomplete fusion of the posterior neural element of C2.
Photo: The external opening of the sinus tract.
Case Discussion
The patient had a history of posterior cervical congenital dermal sinus with recurrent infections (as shown on the current examination).
The repeated attacks of sinus tract infection was once complicated by meningitis. That was subsequently complicated by aqueduct of sylvius distal webs and marked hydrocephalus.
Spinal dermal sinus is a rare entity, which usually comes to clinical attention by cutaneous abnormalities, neurologic deficit, and/or infection
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