intradural epidermoid cyst with atypical magnetic resonance imaging and clinical presentation

Epidermoid cysts are a rare benign neoplasm of spine. They account for only 1% of all benign spinal tumors. These cysts are either congenital or acquired, like after repeated lumbar puncture. They can present anywhere in the spinal cord, and are intradural. They can be intra- or extra-medullary. As the cysts are slow growing, they are mostly reported after some sensorimotor or in some cases after bowel and bladder involvement. Typical magnetic resonance imaging (MRI) findings are a hyperintense signal on T2-weighted (T2W) and hypointense T2W images. Diagnosis is confirmed on histopathologic examination. The treatment is complete excision and if not then maximum debulking of the tumor. We present a case of 27-year-old male with only tingling and mild weakness in the left lower limb. He was diagnosed with intradural tumor with MRI findings showing hyperintense signal on T1-W and isointense signal on T2W images. This is an uncommon presentation. It was enmeshing around rootlets so had to be debulked. The diagnosis was confirmed on histopathologic examination. Postoperatively recovery was excellent with no neurological deficit.