Case Presentation: In this case, we present a 26-year-old female with a 3-week history of worsening back pain, left leg weakness, left leg numbness/tingling, and difficulty urinating, suggestive of incomplete BSS. Upon preoperative imaging, a non-enhancing intradural cystic mass at the level of T3-T4 with mass effect on the spinal cord was revealed. Laminectomy and drainage were performed, and surgical pathology confirmed a benign ependymal cyst. The surgical intervention and subsequent intense physical rehabilitation resulted in a good prognosis.
Discussion: This is a rare case of BSS manifesting due to an intramedullary benign ependymal cyst, rather than trauma, with neurogenic bladder involvement. If a traumatic cause (e.g. herniated disc or cauda equina syndrome) is suspected but is ruled out with computed tomography (CT), magnetic resonance imaging (MRI) can be useful in determining a non-traumatic cause such as intramedullary benign cyst for such radiculopathy.
Conclusions: In an atypical setting of BSS with neurogenic bladder and without history of trauma, an MRI should be utilized to determine the underlying pathology of worsening symptoms. An intramedullary benign ependymal cyst should also be included in the differential for an aberrant presentation of BSS.