Thoracic spinal Pantopaque cyst and associated syrinx resulting in progressive spastic paraparesis: case report.
OBJECTIVE
We describe a unique presentation of a thoracic spinal Pantopaque cyst. Although Pantopaque is no longer used, sequelae of its long-term use may continue to surface.


METHODS
Our patient presented to the emergency room with 4 months of progressive lower extremity numbness, spasticity, and incontinence and a 2-day history of left upper extremity dysesthesias. Magnetic resonance imaging at admission revealed a C7-T10 syrinx and an intrathecal extramedullary mass to the right of the spinal cord at T10-T11.


METHODS
Radiographic evidence led to the initial diagnosis of hemangioblastoma. The results of a critical analysis of the preoperative studies caused us to suspect a Pantopaque cyst. This suspicion was confirmed at the time of surgery, when a cyst filled with contrast medium was revealed. T9-T11 laminectomies were performed, allowing for a 5-cm dural opening. The cyst was aspirated and excised, and then the syrinx was decompressed.


CONCLUSIONS
Our patient experienced significant sensory and motor improvement postoperatively. We present a previously undescribed complication of one of the most commonly used contrast media, Pantopaque. Despite its replacement with newer agents, it may continue to play a significant role in the pathological presentation of patients in whom it was previously used.
Division of Neurosurgery, University of California Los Angeles, School of Medicine, USA.
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Tabor
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Batzdorf
D000328:Adult; D000792:Angiography; D003287:Contrast Media / Q000009:adverse effects*; D003560:Cysts / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007481:Iophendylate / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D015493:Paraparesis, Tropical Spastic / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D013122:Spinal Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D013595:Syringomyelia / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D013909:Thorax
D003287:Contrast Media; D007481:Iophendylate