Rhythmic Neck Muscle Spasms and Upper Limb Muscle Myoclonic Jerks as an Unusual Initial Presentation of Posttraumatic Cervicothoracic Syringomyelia: A Case Report

Abstract

Posttraumatic syringomyelia with an initial presentation of involuntary movement is rare. We describe a 25-year-old patient who sustained complete traumatic spinal cord injury at the thoracic level and presented with rhythmic neck muscle spasms and upper limb muscle myoclonic jerks 1 month after trauma. Magnetic resonance imaging revealed syrinx formation between C3 and T1. Lumbar-peritoneal shunt and decompression were performed. The symptoms completely disappeared after surgery. This report highlights that rhythmic neck muscle spasms and upper limb muscle myoclonic jerks can be the initial and only manifestations of syringomyelia. LEVEL OF EVIDENCE: V.

Surgical Treatment of Upper Extremity Segmental Myoclonus in an Adolescent with Chiari Malformation and Cervicothoracic Syrinx

“…The natural history for the development of PTS is elusive as almost all data are based on retrospective review of imaging obtained for symptomatic syringomyelia after trauma. Classic symptoms include weakness, pain, loss of temperature sensation, paresthesias, spasticity, or bladder and bowel dysfunction [2]. Characteristic electrodiagnostic findings of f-wave prolongation and diminished conduction velocity on motor-evoked potentials have been described [19].…”

“…Although uncommon, PTS presenting with myoclonus has been reported in adults [2,20,21]. Lin et al [2] presented a case of a 25-year-old who had a complete thoracic spinal cord injury and developed PTS from C3-T1. The patient developed rhythmic neck and upper limb myoclonus 1 month after injury.…”

“…In some cases, treatment is purely supportive, whilst in others, pharmacological therapy with antiepileptic drugs or benzodiazepines is effective. Although extremely rare, surgically treatable cases of myoclonus have been reported for conditions such as myoclonus dystonia syndrome [1], spinal myoclonus due to degenerative or traumatic compression myelopathy [2], or Chiari malformation type I (CM-1) [3,4].…”

“…Of those patients with CM-1 who are symptomatic, presenting complaints vary widely. Most commonly, these include occipital headaches, neck pain, and upper extremity paresthesia in adolescents and irritability in younger children [2,9]. CM-1 can also produce more significant neurologic deficits, such as reduced gag reflex, stridor, and bradycardia/apnea episodes.…”