Dural ectasia


Dural ectasia is widening or ballooning of the dural sac surrounding the spinal cord. This usually occurs in the lumbosacral region, as this is where the cerebrospinal fluid pressure is greatest, but the spinal canal can be affected in any plane.

Signs and symptoms

Most common symptoms include lower back pain, headaches, weakness, numbness above and below
the involved limb, leg pain, and sometimes there can be rectal and genital pain. Bowel and bladder dysfunction, urinary retention or even incontinence may occur.
The symptoms are usually exacerbated by upright posture and often but not always relieved by lying down. However, in many patients it is asymptomatic.

Causes

It is common in Marfan syndrome, occurring in 63–92% of people with the syndrome. Dural ectasia may also occur in Ehlers-Danlos Syndrome, neurofibromatosis type I, ankylosing spondylitis, and trauma.
In neurofibromatosis type I it has been theorized that local infiltration of the dura by plexiform neurofibromas leads to a weakening of the dural allowing the outpouching. A retrospective study found that a majority of dural ectasia were associated with nearby plexiform neurofibromas.

Diagnosis

Diagnosis is usually conducted by MRI or CT Scan.

Treatment

has been demonstrated in drug trials to relieve symptoms associated with dural ectasia in individuals with Marfan's syndrome. The majority of dural ectasia do not require surgery and can be treated conservatively.