Hemorrhagic synovial cyst: An unexpected cause of acute cervical spinal cord compression. Case report

Highlights

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  Chronic inflammation of the synovial cyst induces neovascularization of its wall leading to a possible intra-cystic bleeding.

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  The different signal modulations on MRI are due to the variable consistency and density of the cystic fluid.

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  Synovial cyst hemorrhage produces a sudden increase in the size of the lesion with compression of the spinal cord and nerve roots.

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  Surgery is the appropriate treatment in case of synovial cyst with spinal cord compression.

Abstract

Introduction

Cervical synovial cysts are uncommon. They are most often responsible for a chronic clinical picture. Rarely, intracystic hemorrhage occurs, and may acutely present as radicular – or even spinal cord compression syndrome leading to irreversible neurological impairment.

Case

We reported a case of bleeding synovial cyst located in the cervico-thoracic spine causing spastic paraparesis in a 68-year-old male patient. MRI revealed narrowing of perimedullary subarachnoid space by a well circumscribed, extra-axial, homogeneous mass located posterolaterally to the right of the spinal cord at the level C7-T1. The cyst was removed thoroughly by laminectomy. Pathological findings were consistent with the diagnosis of hemorrhagic synovial cyst. The patient had an excellent recovery.

Discussion

Synovial cysts of the spine are rare and usually asymptomatic. It is extremely rare for intracystic bleeding to occur and be responsible for an abrupt presentation. Diagnosis of spinal synovial cyst relies on MRI but may not be evident as it depends on consistency and density of the cystic fluid.

Surgery remains the best therapeutic alternative, especially in the case of neurological impairment.

Conclusion

Surgery should be considered for any cervical synovial cyst. This is motivated by the risk, although rare, of bleeding and the resulting irreversible neurological damage that may occur.