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Carolina Ferreira Pinheiro, Marcos Veiga, Madalena Ferreira, Carla Conceição

- Neuroradiology Department, Hospital Dona Estefânia e Hospital São José, Centro Hospitalar Universitário de Lisboa Central – CHULC

- XV Congresso Nacional da SPNR, 28-29 Junho 2019, Coimbra
- Neuroradiology (2020) 62:109–127.

Introduction/ Objectives: Occult intra-sacral meningoceles are rare congenital conditions. They appear to be intra-sacral extradural cysts caused by arachnoid herniating through a small dural defect in the caudal end of the thecal sac. They can cause sacral canal or foramina dilatation, with an eroded/scalloped bone like appearance of adjacent vertebrae - due to raised intraspinal CSF pressure/pulsation. There may be an associated occult dysraphism. The goal of this work is to present an unusual clinical case of painful presentation of an occult meningocele rupture.
Material and Methods/Results: A 10-years old boy, an uneventful medical history, was admitted to another hospital’s emergency room after a sacral-coccygeal traumatic event. While in the hospital, he developed a severe headache, that eased with the supine position, dizziness and vomiting. Intracranial hypotension was suspected. A lumbar-sacral spine CT confirmed a S3 fracture and, also, revealed an occult dysraphism with posterior sacral bone scalloping. The lumbar spine MRI showed a ruptured sacral meningocele from S2 to S4 with an associated cystic prevertebral and posterior epidural collections. The brain MRI demonstrated diffuse pachymeningeal hyperintensity on FLAIR, corroborating the clinical diagnosis of intracranial hypotension. He was transferred to our center and during the hospital stay, the patient favored a supine position, with symptoms improvement. A second MRI was requested, showing an increased in size of the occult meningocele, filling the spinal canal, with no more evidence of CSF leakage or signs of intracranial hypotension.
Conclusions: The literature regarding occult sacral meningoceles is not vast. In recent years, their incidence has increased due to greater availability of MRI. They can be asymptomatic or symptomatic, most commonly presenting as chronic low back pain or altered bladder or bowel habits. As presented, rarely, intra-sacral meningoceles can present with intracranial hypotension symptoms after spine trauma, due to CSF leakage.

Palavras Chave: sacral meningoceles; Intracranial hypotension; back pain; MRI; trauma