A 17-year-old female patient presented with neck pain since two weeks which was aggravated by exercise and neck movements. She developed weakness of limbs for one week which started in left upper limb and then evolved to involve all four limbs. She also complained of numbness in both upper limbs and urgency of micturation. On neurological examination, tone was mildly decreased in both upper limbs and increased in both lower limbs. Power was 2/5 in left upper limbs and 4/5 in other limbs. Deep tendon reflexes were absent in upper limbs and exaggerated in lower limbs. Pain and touch sensation decreased by 30% below C2 level and vibration sense lost below T2 level.\nMRI [] showed a well circumscribed extra-axial cystic lesion of 3 × 1.8 × 2.4 cm size noted anterior and to the right of medulla extending through foramen magnum into upper cervical canal. It was hyperintense on T1 and T2 weighted images with no diffusion restriction. On right side hypoglossal nerve was displaced laterally by lesion.\nShe underwent suboccipital craniectomy and total excision of the lesion via right lateral approach. Histopathology showed a cyst wall is lined by cuboidal and columnar epithelium with goblet cells (arrow) suggestive of a neuroenteric cyst.\nPostoperatively, patient's power improved to 4/5 in all 4 limbs.
A 17-year-old female patient presented with occasional headache since two years increased since the last three months. On examination, bilateral papilledema was present. No other focal neurological deficits were present.\nMRI [] showed a well-defined CSF-intensity cystic lesion in the region of the fourth ventricle with obstructive hydrocephalus. There were no enhancing solid components. The lesion showed facilitated diffusion. The patient underwent midline suboccipital craniotomy and deroofing of the cyst. Histopathology showed cuboidal or columnar epithelium (pseudostratified at some foci). Based on the immunohistochemical properties, a final diagnosis of neuroenteric cyst was made. Patient did well in the post-operative period with reduction of the hydrocephalus.