Congenital spinal epidermoid cyst presenting as abscess of the spinal cord

Epidermoid cyst in the spinal cord is a rare condition. The majority arise in the cerebellopontine angle or parasellar. They are considered malformations due to incorporation of ectoderm into the folds of the developing nervous system at the time of closure of the neural tube (3.-5. gestational week). They consist of delicate connective-tissue capsule lined by laminated squamous epithelium filled with keratin. In the majority they are associated by further dysrhaphic malformations like dermalsinus, which can be the cause for secondary infection.

We report the case of a 18 months old girl with increasing gait disturbance resulting in subtotal thoraco-lumbar paraplegia.

MRI showed multicystic intraspinal lesions with massive contrastmedium enhancement. Neurosurgical resection revealed an epidermoid cyst with secondary myelitis (E.coli, Proteus mirabilis). Radiologically there was no fistula to be found, so we suggest a haematogenous etiology, maybe by a latent urinary tract infection.

After total resection and 9 weeks of antiobiotic treatment the girl showed a favourable outcome with good regression of the paraplegic symptoms.