OBJECT Intramedullary
dermoid cysts are rare
tumors of the spinal cord. Presentation with rapid onset of
paraparesis or
quadriparesis (onset within 2 weeks) is rarer still. The authors present their experience in the management and outcome of patients with such a presentation. METHODS Patient records between 2000 and 2014 were retrospectively reviewed to identify those with intraspinal
dermoid cysts who presented with rapid-onset
paraparesis or
quadriparesis. Their clinical, radiological, operative, and follow-up data were analyzed. RESULTS Of a total of 50 patients with intraspinal
dermoid cysts managed during the study period, 10 (20%) presented with rapid-onset
paraparesis or
quadriparesis; 9 patients ranged in age from 8 months to 2 years, and 1 patient was 25 years old. A
dermal sinus was seen in the lumbar region of 4 patients, the sacral region of 3, and the thoracic region of 1, and in 1 patient no sinus was found. All except 1 patient presented with rapid-onset
paraparesis secondary to
infection of the intramedullary
dermoid cyst. One patient presented with
rupture of a
dermoid cyst with extension into the central canal up to the medulla. Early surgery was done soon after presentation in all except 2 patients. Among the 9 patients who underwent surgery (1 patient did not undergo surgery), total excision of the intramedullary
dermoid cyst was done in 3 patients, near-total excision in 4 patients, and partial excision in 2 patients. Of the 9 patients who underwent surgery, 8 showed significant improvement in their neurological status, and 1 patient remained stable. The 1 patient who did not undergo surgery died as a result of an uncontrolled
infection after being discharged to a local facility for management of
wound infection. CONCLUSIONS Early recognition of a
dermal sinus and the associated intraspinal
dermoid cyst and timely surgical intervention can eliminate the chances of acute deterioration of neurological function. Even after an acute onset of
paraparesis or
quadriparesis, appropriate
antibiotic therapy and prompt surgery can provide reasonably good outcomes in these patients.