SungBum Kim M.D.1), Kee D Kim M.D.2), Rebecca Sonu M.D.3)

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Kyung Hee University, Department of Neurosurgery, Seoul, Korea1) UC Davis Medical Center, Department of Neurosurgery, California, USA2)

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UC Davis Medical Center, Department of Pathology and Laboratory Medicine, California, USA3)

Corresponding Author: Kee D Kim M.D.

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UC Davis Medical Center, Department of Neurosurgery, California, USA Address ; 4860 Y street, Ste3740, Sacramento, CA 95817

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Tel : 916-734-3102

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Fax : 916-734-5368

The manuscript submitted does not contain information about medical device(s)/drug(s).

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No funds were received in support of this work. submitted work.

Unknown Case (Part I)  Clinical presentation

No relevant financial activities outside the

A 56-year-old man presented with worsening back pain for three weeks with numbness over the right anterior shin for the past week. He had no prior history of trauma and denied fever, chills, night sweats, bowel or bladder dysfunction. His past medical history included hypertension, alcohol abuse and herpes simplex infection. On neurologic examination, he had numbness involving the right L4 dermatome with Routine laboratory studies including erythrocyte

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decreased Achilles reflex on that side.

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sedimentation rate (ESR) and C-reactive protein (CRP) were within normal limits.

Lumbar magnetic resonance imaging (MRI) was performed one week after the clinic visit

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Figure Legends

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(Figures 1 & 2), and Gadolinium was administered (Figure 3).

1. T1-weighted lumbar MRI (sagittal and L4-5 axial images).

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2. T2-weighted lumbar MRI (sagittal and L4-5 axial images)

3. Contrast-enhanced lumbar MRI (sagittal and L3-4 and L4-5 axial images).

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4. Microscopic images of the synovial cyst lining. A) Low-power (x10) view showing

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synovial endothelium overlying fibrous tissue with myxoid change. B) High-power (x100) view of the synovial endothelium with hemosiderin-laden macrophages and

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chronic inflammation consistent with hematoma.

Unknown Case: Part 1.

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