Role of screening of whole spine with sagittal MRI with MR myelography in early detection and management of occult intrasacral meningocele
A twenty-year-old male presented with a history of weakness in the lower limbs and urinary incontinence. Sagittal T2-weighted MRI and MR myelography showed a large biloculated cystic lesion at S1-S5 level measuring approximately 10.1×4.5×2.5 cm. The upper locule of the lesion was partially communicating with the thecal sac. There was a thin septum between the upper and lower locules. The upper locule displayed CSF signal intensity on all sequences, whereas the lower locule appeared hyperintense on gradient diffusion imaging suggestive of a high protein content. Conus Medullaris terminated at the L3-L4 level with a slightly thickened fatty filum terminale. In addition, significant distension of urinary bladder with diverticulation of its wall was seen. This suggested the possibility of a neurogenic bladder [Figure –]. Excision of the cyst was performed along with the release of the filum terminale. During follow-up at around fourteen months, the patient had a fair outcome. Some degree of weakness persisted in the lower limbs, whereas urinary incontinence had improved significantly. The follow-up MR imaging showed a recurrent cyst in the sacrum measuring about 7.7×2.2×3.0 cm. However, the urinary bladder exhibited a reduction in the thickening of its wall.