{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:58:28Z","timestamp":1785286708287,"version":"3.55.0"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,7,27]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Spinal arachnoid webs (SAWs) are an uncommon cause of spinal cord compression, typically presenting with an insidious onset of symptoms. Their role in acute neurological deterioration is not well established, and the underlying pathophysiology remains debated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The authors describe the case of a 62-year-old male who presented with acute thoracic back pain and rapidly progressive unilateral lower limb weakness, evolving to paraplegia within hours. The initial deficit was highly atypical for a dorsally located compressive lesion, creating significant diagnostic uncertainty. Imaging revealed a T5\u20137 dorsal arachnoid web, which was considered an incidental finding given the atypical presentation. Subsequent imaging demonstrated web enlargement and the development of an owl\u2019s-eye T2 hyperintensity, indicative of anterior spinal cord ischemia. Emergency surgical decompression and arachnolysis were performed, leading to partial neurological recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case challenges the conventional understanding of SAWs as slowly progressive lesions and highlights the diagnostic complexity introduced by atypical presentations. The location of the web in a vascular watershed zone of the midthoracic spine likely contributed to the development of cord ischemia, which was suspected to be the primary driver of the patient\u2019s fulminant course. This case underscores the importance of considering SAWs in the differential diagnosis of acute myelopathy.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE2682\">https:\/\/thejns.org\/doi\/10.3171\/CASE2682<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case2682","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:01:15Z","timestamp":1784678475000},"source":"Crossref","is-referenced-by-count":0,"title":["Unmasking the role of a thoracic arachnoid web and watershed ischemia in rapidly progressing paraplegia: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"given":"Therese","family":"Phua","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishwarya","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Nichols","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saif","family":"Yousif","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2797-8079","authenticated-orcid":true,"given":"Patrick","family":"Donnelly","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Garcia-Redmond","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"J Spine Surg","first-page":"446","article-title":"Spinal arachnoid web\u2014a review article","volume":"4","author":"Ben Ali","year":"2018","unstructured":"Ben Ali HHamilton PZygmunt SYakoub KM.Spinal arachnoid web\u2014a review article. J Spine Surg. 2018;4(2):446-450. doi:10.21037\/jss.2018.05.08"},{"issue":"5","key":"bib2","series-title":"AJNR Am J Neuroradiol","first-page":"1104","article-title":"Dorsal thoracic arachnoid web and the \u201cscalpel sign\u201d: a distinct clinical-\u00adradiologic entity","volume":"34","author":"Reardon","year":"2013","unstructured":"Reardon MARaghavan PCarpenter-Bailey KDorsal thoracic arachnoid web and the \u201cscalpel sign\u201d: a distinct clinical-\u00adradiologic entity. AJNR Am J Neuroradiol. 2013;34(5):1104-1110. doi:10.3174\/ajnr.A3432"},{"issue":"2","key":"bib3","series-title":"J Neurosurg","first-page":"287","article-title":"Dorsal arachnoid web with spinal cord compression: variant of an arachnoid cyst? Report of two cases","volume":"93","author":"Paramore","year":"2000","unstructured":"Paramore CG.Dorsal arachnoid web with spinal cord compression: variant of an arachnoid cyst? Report of two cases. J Neurosurg. 2000;93(2)(suppl):287-290. doi:10.3171\/spi.2000.93.2.0287"},{"issue":"1","key":"bib4","series-title":"Neurosurgery","first-page":"E216","article-title":"Transverse dorsal arachnoid web and syringomyelia: case report","volume":"65","author":"Sridharan","year":"2009","unstructured":"Sridharan AHeilman CB.Transverse dorsal arachnoid web and syringomyelia: case report. Neurosurgery. 2009;65(1):E216-E217. doi:10.1227\/01.NEU.0000348007.84175.FA"},{"issue":"6","key":"bib5","series-title":"J Neurosurg Spine","first-page":"711","article-title":"Spinal arachnoid cysts in adults: diagnosis and management. A single-center experience","volume":"29","author":"Fam","year":"2018","unstructured":"Fam MDWoodroffe RWHelland LSpinal arachnoid cysts in adults: diagnosis and management. A single-center experience. J Neurosurg Spine. 2018;29(6):711-719. doi:10.3171\/2018.5.SPINE1820"},{"key":"bib6","series-title":"Brain Spine","article-title":"Spinal arachnoid cysts: a case series & systematic review of the literature","volume":"2","author":"Kalsi","year":"2022","unstructured":"Kalsi PHejrati NCharalampidis ASpinal arachnoid cysts: a case series & systematic review of the literature. Brain Spine. 2022;2:100904. doi:10.1016\/j.bas.2022.100904"},{"issue":"suppl 2","key":"bib7","series-title":"Eur Spine J","first-page":"S124","article-title":"Spinal cord compression caused by idiopathic intradural arachnoid cysts of the spine: review of the literature and illustrated case","volume":"19","author":"Petridis","year":"2010","unstructured":"Petridis AKDoukas ABarth HMehdorn HM.Spinal cord compression caused by idiopathic intradural arachnoid cysts of the spine: review of the literature and illustrated case. Eur Spine J. 2010;19(suppl 2):S124-S129. doi:10.1007\/s00586-009-1156-9"},{"issue":"2","key":"bib8","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Causes of arachnoid cyst development and expansion","volume":"22","author":"Basaldella","year":"2007","unstructured":"Basaldella LOrvieto EDei Tos APDella Barbera MValente MLongatti P.Causes of arachnoid cyst development and expansion. Neurosurg Focus. 2007;22(2):E4. doi:10.3171\/foc.2007.22.2.4"},{"key":"bib9","series-title":"Brain Spine","first-page":"104336","article-title":"Arachnoid web\u2014a rare but surgically effectively treatable cause of spinal cord compression and syringomyelia","volume":"5","author":"Na","year":"2025","unstructured":"Na CHRidwan HNeuloh GArachnoid web\u2014a rare but surgically effectively treatable cause of spinal cord compression and syringomyelia. Brain Spine. 2025;5:104336. doi:10.1016\/j.bas.2025.104336"},{"issue":"7","key":"bib10","series-title":"Radiol Case Rep","first-page":"2706","article-title":"Spinal cord watershed infarction after surgery","volume":"19","author":"Nguyen","year":"2024","unstructured":"Nguyen GNguyen GKMor\u00f3n FE.Spinal cord watershed infarction after surgery. Radiol Case Rep. 2024;19(7):2706-2709. doi:10.1016\/j.radcr.2024.03.034"},{"issue":"uppl 25","key":"bib11","series-title":"Surg Neurol Int","first-page":"S682","article-title":"Effect of spinal cord compression on local vascular blood flow and perfusion capacity by Alshareef M, Krishna V, \u00adFerdous J, Aishareef A, Kindy M, Kolachalama VB, et al","volume":"7","author":"Epstein","year":"2016","unstructured":"Epstein NE.Effect of spinal cord compression on local vascular blood flow and perfusion capacity by Alshareef M, Krishna V, \u00adFerdous J, Aishareef A, Kindy M, Kolachalama VB, et al. Surg Neurol Int. 2016;7(suppl 25):S682-S685. doi:10.4103\/2152-7806.191077"},{"issue":"1","key":"bib12","series-title":"J Neurointerv Surg","first-page":"67","article-title":"Vascular anatomy of the spinal cord","volume":"4","author":"Santillan","year":"2012","unstructured":"Santillan ANacarino VGreenberg ERiina HAGobin YPPatsalides A.Vascular anatomy of the spinal cord. J Neurointerv Surg. 2012;4(1):67-74. doi:10.1136\/neurintsurg-2011-010018"},{"issue":"5","key":"bib13","series-title":"AJNR Am J Neuroradiol","first-page":"825","article-title":"Spinal cord ischemia: practical imaging tips, pearls, and pitfalls","volume":"36","author":"Vargas","year":"2015","unstructured":"Vargas MIGariani JSztajzel RSpinal cord ischemia: practical imaging tips, pearls, and pitfalls. AJNR Am J Neuroradiol. 2015;36(5):825-830. doi:10.3174\/ajnr.A4118"},{"issue":"8","key":"bib14","series-title":"Spine J","first-page":"1199","article-title":"Symptomatic secondary spinal arachnoid cysts: a systematic review","volume":"23","author":"Wang","year":"2023","unstructured":"Wang YBWang DHDeng SL.Symptomatic secondary spinal arachnoid cysts: a systematic review. Spine J. 2023;23(8):1199-1211. doi:10.1016\/j.spinee.2023.03.002"},{"issue":"11","key":"bib15","series-title":"J Neurosurg Case Lessons","first-page":"CASE23701","article-title":"Resection of an incidentally discovered spinal arachnoid web: illustrative case","volume":"7","author":"Vattipally","year":"2024","unstructured":"Vattipally VNAhmadi SWeber-Levine CResection of an incidentally discovered spinal arachnoid web: illustrative case. J Neurosurg Case Lessons. 2024;7(11):CASE23701. doi:10.3171\/CASE23701"},{"issue":"3-4","key":"bib16","series-title":"Acta Neurochir (Wien)","first-page":"227","article-title":"Post traumatic spinal arachnoid cysts","volume":"70","author":"Lesoin","year":"1984","unstructured":"Lesoin FRousseau MThomas CE IIIJomin M.Post traumatic spinal arachnoid cysts. Acta Neurochir (Wien). 1984;70(3-4):227-234. doi:10.1007\/BF01406651"},{"issue":"1","key":"bib17","series-title":"J Belg Soc Radiol","first-page":"12","article-title":"Post-traumatic focal adhesive arachnoiditis","volume":"101","author":"Zigic","year":"2017","unstructured":"Zigic VRistic JTurkalj IVanhoenacker FM.Post-traumatic focal adhesive arachnoiditis. J Belg Soc Radiol. 2017;101(1):12. doi:10.5334\/jbr-btr.1161"},{"issue":"4","key":"bib18","series-title":"Neurosurgery","first-page":"804","article-title":"Ultrastructural evidence for arteriolar vasospasm after spinal cord trauma","volume":"39","author":"Anthes","year":"1996","unstructured":"Anthes DLTheriault ETator CH.Ultrastructural evidence for arteriolar vasospasm after spinal cord trauma. Neurosurgery. 1996;39(4):804-814. doi:10.1097\/00006123-199610000-00032"},{"issue":"7","key":"bib19","series-title":"Phys Ther","first-page":"673","article-title":"Vascular events after spinal cord injury: contribution to secondary pathogenesis","volume":"80","author":"Mautes","year":"2000","unstructured":"Mautes AEWeinzierl MRDonovan FNoble LJ.Vascular events after spinal cord injury: contribution to secondary pathogenesis. Phys Ther. 2000;80(7):673-687. doi:10.1093\/ptj\/80.7.673"},{"key":"bib20","series-title":"BioMed Res Int","first-page":"384342","article-title":"Inflammation, vasospasm, and brain injury after subarachnoid hemorrhage","volume":"2014","author":"Miller","year":"2014","unstructured":"Miller BATuran NChau MPradilla G.Inflammation, vasospasm, and brain injury after subarachnoid hemorrhage. BioMed Res Int. 2014;2014:384342. doi:10.1155\/2014\/384342"},{"issue":"1","key":"bib21","series-title":"J Neurosurg Case Lessons","first-page":"CASE25734","article-title":"Arachnoid web presenting with acute myelopathy after minor trauma and subtle imaging findings: illustrative case","volume":"11","author":"Tsukamoto","year":"2026","unstructured":"Tsukamoto SHidaka GUchida MArachnoid web presenting with acute myelopathy after minor trauma and subtle imaging findings: illustrative case. J Neurosurg Case Lessons. 2026;11(1):CASE25734. doi:10.3171\/CASE25734"},{"issue":"1","key":"bib22","series-title":"Korean J Spine","first-page":"32","article-title":"Spinal extradural arachnoid cyst: a case report","volume":"10","author":"Kong","year":"2013","unstructured":"Kong WKCho KTHong SK.Spinal extradural arachnoid cyst: a case report. Korean J Spine. 2013;10(1):32-34. doi:10.14245\/kjs.2013.10.1.32"},{"issue":"1","key":"bib23","series-title":"Fluids Barriers CNS","first-page":"5","article-title":"Diverse arachnoid cyst morphology indicates different pathophysiological origins","volume":"11","author":"Rabiei","year":"2014","unstructured":"Rabiei KTisell MWikkels\u00f8 CJohansson BR.Diverse arachnoid cyst morphology indicates different pathophysiological origins. Fluids Barriers CNS. 2014;11(1):5. doi:10.1186\/2045-8118-11-5"},{"issue":"1","key":"bib24","series-title":"J Neurosurg Pediatr","first-page":"62","article-title":"Arachnoid cyst slit valves: the mechanism for arachnoid cyst enlargement","volume":"12","author":"Halani","year":"2013","unstructured":"Halani SHSafain MGHeilman CB.Arachnoid cyst slit valves: the mechanism for arachnoid cyst enlargement. J Neurosurg Pediatr. 2013;12(1):62-66. doi:10.3171\/2013.4.PEDS12609"},{"issue":"2","key":"bib25","series-title":"J Neurosurg Spine","first-page":"175","article-title":"Arachnoid web of the spine: a systematic literature review","volume":"31","author":"Nisson","year":"2019","unstructured":"Nisson PLHussain IH\u00e4rtl RKim SBaaj AA.Arachnoid web of the spine: a systematic literature review. J Neurosurg Spine. 2019;31(2):175-184. doi:10.3171\/2019.1.SPINE181371"},{"issue":"3","key":"bib26","series-title":"J Neurosurg Spine","first-page":"238","article-title":"Blood supply and vascular reactivity of the spinal cord under normal and pathological conditions","volume":"15","author":"Martirosyan","year":"2011","unstructured":"Martirosyan NLFeuerstein JSTheodore NCavalcanti DDSpetzler RFPreul MC.Blood supply and vascular reactivity of the spinal cord under normal and pathological conditions. J Neurosurg Spine. 2011;15(3):238-251. doi:10.3171\/2011.4.SPINE10543"},{"issue":"9","key":"bib27","series-title":"PLoS One","first-page":"e108820","article-title":"Effect of spinal cord compression on local vascular blood flow and perfusion capacity","volume":"9","author":"Alshareef","year":"2014","unstructured":"Alshareef MKrishna VFerdous JEffect of spinal cord compression on local vascular blood flow and perfusion capacity. PLoS One. 2014;9(9):e108820. doi:10.1371\/journal.pone.0108820"},{"issue":"2","key":"bib28","series-title":"J Gen Fam Med","first-page":"63","article-title":"Anterior spinal cord syndrome\u2014\u201cowl\u2019s eye sign\u201d","volume":"19","author":"Harada","year":"2018","unstructured":"Harada KChiko YToyokawa T.Anterior spinal cord syndrome\u2014\u201cowl\u2019s eye sign\u201d. J Gen Fam Med. 2018;19(2):63-64. doi:10.1002\/jgf2.156"},{"issue":"5","key":"bib29","series-title":"AJNR Am J Neuroradiol","first-page":"987","article-title":"Spinal cord ischemia after resection of thoracoabdominal aortic aneurysms: MR findings in 24 patients","volume":"11","author":"Mawad","year":"1990","unstructured":"Mawad MERivera VCrawford SRamirez ABreitbach W.Spinal cord ischemia after resection of thoracoabdominal aortic aneurysms: MR findings in 24 patients. AJNR Am J Neuroradiol. 1990;11(5):987-991. doi:10.2214\/ajr.155.6.2122684"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/4\/article-CASE2682.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/4\/article-CASE2682.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/4\/article-CASE2682.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:01:00Z","timestamp":1785283260000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/4\/article-CASE2682.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":29,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/case2682","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,27]]}}}