Aetiological diagnosis of cervical myelopathy with characterisation of the underlying pathology can be done well by MRI, which has established itself as the imaging modality of choice for assessment of intervertebral discs, spinal cord,
subarachnoid space, ligaments and other soft tissues in relation to spine.
In fact, our patient previously underwent a shunting operation using a silicone tube to establish a communication between the cyst cavity and the
subarachnoid space with a posterior approach 22 years ago, which eventually failed to function.
This phenomenon generally occurs as the result of an abnormal communication between the perilymphatic and
subarachnoid spaces. (1) The abnormal communication with the
subarachnoid spaces might involve the cochlear duct or internal auditory canal.
An aneurysm that has ruptured into the
subarachnoid space is a very serious condition.
A similar appearance in the CT of the head may occur in the absence of blood in the
subarachnoid spaces. This distinct finding is referred to as pseudosubarachnoid hemorrhage (pseudo-SAH).
With expiration, positive intrathoracic pressure drives air in the
subarachnoid space resulting in pneumocephalus.
Caption: Figure 2: The transverse view of the CT scan shows air accumulation in the
subarachnoid space indicating a pneumocephalus.
Spontaneous subarachnoid hemorrhage (SAH), characterized by bleeding into the
subarachnoid space in the absence of trauma, is most often caused by the rupture of an intracranial aneurysm [1, 2].
The patients were identified from our database through the terms: "idiopathic intracranial hypertension", "benign intracranial hypertension", "empty sella", and "distension of the perioptic
subarachnoid space".
According to the classical hypothesis of cerebrospinal fluid (CSF) flow dynamics, CSF is produced within the ventricular system and it circulates toward the
subarachnoid space where it is absorbed and a blockage between ventricular and
subarachnoid spaces would cause an increase of intraventricular pressure and dilatation of brain ventricles (5).
It consists of small pump or reservoir that is surgically located under the skin of the abdomen and transports medication through a catheter to intrathecal space or
subarachnoid space.
However, in some cases, like the one described above, it can be associated with brachial plexus palsy in a probable relationship with spread toward the subdural or
subarachnoid space. (8,9)
