Sacral Perineurial Cysts
THE diagnosis of a sacral perineurial cyst may be difficult to establish because of the location caudad to the tip of the dural sac and because the cysts do not communicate with the subarachnoid space. Spinal fluid manometries and analysis, as well as intradural contrast myelography, have proved of no value. The progressive development of a clinical picture pointing to the sacral portion of the cauda equina is perhaps the best indication. The entity should be suspected and searched for in the occasional patient when, at laminectomy for sciatica, the protruding disk is not disclosed.
The patient described showed clinical findings of a lesion compressing the sacral portion of the cauda equina which was found at operation to be an extradural cyst.
A 40 year old white housewife was first seen in the Department of Urology at the Cleveland Clinic in August, 1949 because of headaches and urinary retention. Four years previously she first experienced increasing frequency, nocturia, and a suprapubic bearing-down sensation when reclining. There had been hesitancy, small urinary stream, and even with straining, incomplete emptying of the bladder. In November 1949, complete retention of urine developed. The patient was hospitalized elsewhere for 10 days for repeated catheterization, after which she was able to void with difficulty. Three days before admission complete retention again occurred. During the past 3 months she had progressive occipital and retro-orbital headache, more severe when reclining. In the past 2 months a dull, aching pain in the anterior aspect of the. . .