Cyst of the medullary conus

Case contributed by Mostafa Elfeky
Diagnosis almost certain

Presentation

Back pain and bilateral lower limb weakness.

Patient Data

Age: 30 years
Gender: Female

Dorsolumbar spine

mri

An oval-shaped vertically-oriented intramedullary cystic lesion is noted at the conus medullaris, opposite T12 vertebral body, with a thin non-enhancing wall and clear fluid content with similar signal intensity to CSF in all pulse sequences including DWI. 

Multiple small gall stones are incidentally noted (axial T2).

Case Discussion

Features are impressive of cyst of the medullary conus, a rare benign cystic lesion of the medullary conus that can be symptomatic. It has other synonyms, like persistent ventriculus terminalis or 5th ventricle. 

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