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Dural Ectasia

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Dural ectasia

Within the central nervous system (CNS), the brain and spinal column are surrounded by fluid contained in a membrane called the dura, the tough covering of the brain and spine, which is primarily made up of connective tissue. The enlargement/swelling and distortion of this membrane is referred to as "dural ectasia."

On X-Rays or CT studies, dural ectasia can lead to scalloping (a series of curved projections) of the posterior vertebral bodies and to the formation of cystic diverticula of the dura of the spine (termed meningoceles). Dural ectasia also includes perineural (around a nerve or group of nerves) cysts and meningocele cysts. It can also cause severe bony erosions of the lumbosacral spine.

Research suggests that the presence of dural ectasia does not always cause problems, although it sometimes causes back, abdominal and leg pain and headaches in some affected persons. Dural ectasia may cause dural leaks or a reduction of cerebral spinal fluid around the brain because the fluid has pooled in the lower back. The loss of fluid is thought to sometimes produce headaches.

Sample image of dural ectasia - arrows indicate where the dural ectasia is occurring.

Dural ectasia can occur in the neck or in the upper torso, but it is very rare. In 99% of patients with dural ectasia, it occurs in the lowest part of the spine because this is where the fluid pressure is greatest when standing.

Dural ectasia can present itself following trauma, but it doesn't commonly occur this way.

Dural ectasia does thin the spinal vertebrae. It can have implications for a person having surgery on the spine for any reason.

Symptoms

The symptoms of dural ectasia vary. They include aching in the very low back, almost in the tailbone, abdominal pain, headaches, proximal leg pain, weakness and numbness above and below the knee, and genital/rectal pain. Perineal pain and numbness can also occur because of the lowest sacral nerve roots. Headaches may occur when a person stands up from a seated position. Headaches often occur in conjunction with lower back pain and may be migraine-like in nature.

Unfortunately, there is a significant overlap with the low back pain that anyone in the general population can develop. The difference may be one of age and degree.

Symptoms are typically moderate to severe, occur several times per week (often daily), get worse when sitting or standing upright for too long, and are only sometimes relieved by recumbency (lying down).

Diagnosis

The need for an evaluation depends on the degree of symptoms and disability. If the symptoms are tolerated, there is no urgency to be evaluated.

Dural ectasia is best identified through MRI imaging, particularly of the lower spine with a person standing upright, although flat MRIs (with the person lying down) are fine as well. A mylogram, CT scan, or plain spinal films might also reveal the presence of dural ectasia.

Treatment

Currently, pain management is the mainstay of treatment. Unfortunately, it is not possible to replace the dura. Some surgical treatment of "sacs" of dural ectasia or extreme cases may be undertaken on a case-by-case basis.

For headaches related to dural ectasia, acetazolamide (a medication given to high-altitude climbers) may be helpful.

Additional resources

Living With Marfan Syndrome: Dural Ectasia, from the National Marfan Foundation.

Page last modified on August 01, 2008, at 09:49 PM EST

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