Abstract
INTRODUCTION: Neurenteric cysts (NECs) are rare congenital lesions typically considered benign and slow-growing. However, under certain circumstances, they can lead to devastating neurological outcomes. RESEARCH QUESTION: What mechanisms could explain acute tetraplegia in spinal neurenteric cysts without radiological evidence of severe compression? MATERIALS AND METHODS: A comprehensive literature search was conducted using PubMed, MEDLINE, and Google Scholar with the keywords "neurenteric cyst," "spinal neurenteric cyst," "tetraplegia," "quadriplegia," and "acute neurological deterioration." Studies describing spinal neurenteric cysts presenting with acute or sudden neurological decline were included. RESULTS: We report a unique case of a 38-year-old previously healthy woman who developed sudden tetraplegia secondary to a cervical spinal NEC. Despite early imaging revealing mild spinal cord compression, the patient experienced acute neurological deficits requiring urgent surgical intervention. Complete cyst resection was achieved via a posterior approach, but the patient remained tetraparetic with only minimal recovery at follow-up. CONCLUSION: This case illustrates the unpredictable nature of spinal NECs. Literature review revealed few similar cases, mostly in children. Early surgical resection should be considered in select cases to prevent irreversible damage.