Post-traumatic syringomyelia

Abstract

Post-traumatic syringomyelia is estimated to develop in more than 20% of individuals with traumatic spinal cord injury (SCI). The development can give rise to clinical symptoms 6 months to 26 years after the injury, and presentation 40 years post-injury has been seen by one of the authors. 1 ± 4 We present an unusual case for comments and discussion.Keywords: spinal cord injury; post-traumatic syringomyelia; tetraplegia; progressive symptoms Case storyA forty-year-old man was involved in an accident as a passenger in a rally car, which rolled over several times. He was found to have fractures of the right 2nd and 3rd ribs with bilateral lung contusion, a fracture of the right scapula and right 2nd metacarpal bone. He was initially described as having normal sensation and movement of the legs. He was ventilated and sedated for the ®rst 8 days. Due to urinary retention and generally decreased strength in the lower extremities additional investigations were carried out and a T3 ± 4 fracture dislocation was diagnosed, with half a vertebral body slip anteriorly and laterally of T3 on T4. Thirteen days post-injury he was transferred to a neurosurgical department, where it was decided to continue conservative treatment of the fracturedislocation. Sensation still was found to be normal, including in the sacral segments, there was normal voluntary anal contraction, but the muscle strength in the lower extremities was around 4, and co-ordination was impaired. A few days later the patient could empty the bladder normally. Five-and-a-half weeks postinjury he was admitted to the rehabilitation department, and discharged after a further 8 weeks of rehabilitation. At discharge he had normal voiding and defecation, and was walking nearly normally. He had some co-ordination problems and sensory disturbance of the left leg, and a 10 cm broad band with dysaesthesia on the left thorax. He was not followed up after discharge.Approximately 8 years later he noticed light sensory disturbances ®rst in the right and later the left C 8 segment. An MRI was performed repeatedly over the next 3 years and showed, apart from the known fracture, a lobulated syrinx from the level of the fracture to the upper border of C5. In addition the MRI showed a 3 cm long intramedullary cyst at the level of T5. Fourteen years post-injury his symptoms had progressed with disturbed sensibility in all ®ngers except the thumbs, increasing coordination problems in the right leg, and urinary retention necessitating intermittent catheterisation, together with loss of ejaculation, impaired erection, and increasing di culty in controlling defaecation. An MRI showed the syrinx had increased in size cranially, with only minimal medullary tissue remaining (Figure 1). Fifteen years post-injury he was transferred to our department and a syringoperitoneal shunt was performed. At the time of operation he was almost anaesthetic and analgesic below T 4 , but he could walk without aids. After the operation there was some regression of the sensory disturbances in the hands. T...

25 years or more after spinal cord injury: clinical conditions of individuals in the florence and stockholm areas

“…Neurological deterioration was found in 14% of the patients in both the countries. This figure is o20%, the estimation in the article by Nielsen et al 14 This may have to do with the fact that our duration of injury was somewhat less than in the Nielsen study. Nielsen et al showed that syringomyelia can give rise to symptoms 26 years after injury.…”

Treatment of posttraumatic syringomyelia

“…19,39,47,66 However, not all types of pain respond equally to successful treatment of posttraumatic syringomyelia. Pain provoked by maneuvers such as coughing or sneezing usually improves if the syrinx regresses postoperatively.…”

The translational dialogue in spinal cord injury research

“…The development of post-traumatic syringomyelia is a well-known example where even extensive changes in spinal cord morphology are detected, either by chance (routine MRI scans) or due to the development of rather minor and less specific symptoms (like increasing pain and spasticity) (Figure 3). [43][44][45][46] The common denominator is that these disorders and related changes occur very slowly. This provides evidence that the cord is capable of tremendous plastic changes over a relatively long time.…”