Syringomyelia and bilateral vocal fold palsy

Abstract

This is a case of a 35-year-old who had complained of noisy breathing for 15 years, and had been on treatment for 'chronic asthma'. She presented to the Accident and Emergency department with an acute episode of difficulty with breathing, and on admission was found to have stridor and bilateral abductor vocal fold palsy. Further workup revealed a syringomyelia with an associated Chiari type 1 malformation. It is important to consider the above diagnosis in the differential of young adults with breathing difficulties. A discussion of syringomyelia, Chiai malformations and bilateral vocal fold palsy follows.

Arnold-Chiari type I malformation presenting as benign paroxysmal positional vertigo in an adult patient

“…2,13 Surgical decompression is the mainstay of treatment and surgical techniques include posterior fossa bony decompression, cervical laminectomy, and duraplasty. 5 In the present case, posterior fossa bony decompression and duraplasty were performed. In conclusion, benign paroxysmal positional vertigo recurrences after appropriate canalith repositioning manoeuvres need further neurotologic evaluation.…”

“…8,9 Arnold-Chiari malformations may be associated with hydrocephalus, syringomyelia and cranio-occipital bone malformations, and haemodynamic theories are also used to explain these associations. 2,3,5 In contrast to types II, III and IV, Arnold-Chiari type I malformation does not usually present until the fourth to sixth decade of life. There is a slight female preponderance ( female:male ratio of 1.5:1).…”

“…1,3,4 The first cases were documented by Cleland in 1883, who demonstrated brainstem and cerebellar herniation through an occipital cranial defect in two infant autopsies, then in 1894 Arnold reported a case of cerebellar herniation with an associated spina bifida, and in 1896 Chiari classified the malformations into four types. 1,5 Benign paroxysmal positional vertigo is one of the most common causes of dizziness and is characterized by brief, episodic, and intermittent attacks of vertigo and typical nystagmus produced by certain provocative head movements. 6 Although it has been associated with various otologic pathologies and comorbid diseases most cases are thought to be idiopathic.…”

An Unusual Presentation of Syringomyelia

“…1 Vocal fold palsy is rarely the presenting complaint of an adult with syringomyelia or a Chiari malformation. 2 In this article we describe a case of syringomyelia with syringobulbia and a Chiari type 1 malformation presenting with sole symptom of bilateral vocal cord palsy.…”