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Post-traumatic syringomyelia following complete neurological recovery.

OBJECTIVE: To describe the later neurologic deterioration secondary to the appearance of a post-traumatic syringomyelic cavity, in a patient who, in the initial phase, had an incomplete spinal cord lesion (ASIA C), which improved to ASIA E. METHODS: A 52-year-old male patient who, at the age of 19 (1965), suffered a spinal cord injury. He presented with a fracture of the sixth and seventh cervical neurological segment at the time of the lesion, evolving to ASIA E. Nine years after the traumatism, he began to feel pain accompanied by a sensory and motor deficit. RESULTS: With the aid of myelography and MRI, the existence of a syringomyelic cavity was detected, which extended from the fourth to the seventh cervical segments. The patient was operated on, on various occasions, placing a syringo-subarachnoid shunt. The neurological status of the patient continued to deteriorate and, at present, he has a complete lesion below the fourth neurological cervical segment with a partially preserved sensitive area up to T1. CONCLUSION: The development of the syringomyelic cavity could be one of the causes of later neurologic deterioration in patients with traumatic spinal cord injury with neurological recovery 'ad integrum' in the initial phase of spinal cord injury.

Cervical Vertebrae↗

A case of Arnold-Chiari syndrome with flaccid paralysis and huge syringomyelia.

STUDY DESIGN: A case report. SETTING: Department of Orthopaedic Surgery, Shiga University of Medical Science, Japan. PATIENT: A 13-year-old woman presented progressive weakness in the lower extremities, with predominance on the right. Magnetic resonance (MR) imaging revealed a huge syrinx. The patient also showed scoliosis, cleft palate, hearing impairment, excessive sweating, hairiness, dural ectasia, and malformation of the skull. METHOD AND OBJECTIVES: We treated a very rare case of Arnold-Chiari syndrome, which presented with flaccid paralysis. Methods of differential diagnosis and suitable treatment are discussed. RESULTS AND CONCLUSION: Both the syrinx and muscle strength were quickly improved following placement of a syringo-peritoneal (S-P) shunt, after which the patient recovered the ability to walk. However, transient hypesthesia in the right hand occurred after the operation. The syrinx around the conus was thought to play a crucial role in the etiology of the patient case, which showed unique symptoms.

Adolescent↗

[Arthropathy of the shoulder joint in syringomyelia].

Based on 4 long time observations of syringomyelitic arthropathy and the literature, the clinical and roentgenological picture, the differential diagnosis, the course and the limited chances of treatment are discussed. As to diagnosis initial shoulder pain, pseudophlegmoneous swelling of the shoulder, rupture of the long tendon of the biceps muscle and bone appositions at the medialcaudal portion of the humeral neck-head area and at the lower margin of the acetabulum are emphasized as well as small destructions of the greater tubercle, prior to extensive bone resorption. As to therapy a reserved indication towards synovectomy and refixation of the long biceps tendon is recommended, especially towards bigger interventions. Following decrease of inflammatory processes, on the other hand, guided exercises for support of functional adaptation of the destroyed joint elements are favoured.

Arthritis↗

Posttraumatic syringomyelia: predisposing factors.

Posttraumatic spinal cord cavitation (syrinx) and progressive myelopathy associated with a posttraumatic syrinx (PTS) have been recognized for many years. Predisposing factors for PTS have not been well defined. All symptomatic PTS patients (n = 58) treated at the University of Toronto neurosurgical units over 30 years were analysed retrospectively to discover risk factors for the development of PTS. There were 46 males and 12 females (mean age 42.2 years); 28 patients had cervical (CSCI), and 30 had thoracic and lumbar spinal cord injuries (TSCI). Neurological deficit was complete in 40 (69%) compared with 43% complete injuries in the concurrent spinal and injury (SCI) population in general (p = 0.0003). Onset of PTS was earlier with: increasing age (p < 0.02), cervical and thoracic levels of injury (p < 0.007 and p < 0.02, respectively, compared with lumbar injuries), dislocated fractures (p < 0.003) and spinal surgery (p < 0.001) and, marginally, with complete SCI (p = 0.06). Mean time to onset of PTS appears to have decreased in recent years (p < 0.0001). PTS follows complete spinal cord injury (SCI) more often than incomplete and is frequently associated with arachnoiditis. Onset is earlier with increasing age, cervical and thoracic levels compared with lumbar, displaced fractures and spinal instrumentation without decompression. A group of SCI patients who are at greater risk of developing early PTS is thus identified, facilitating cost-effective follow-up.

Adolescent↗

Arnold-Chiari malformation with syringomyelia in an elderly woman.

PRESENTATION: A 76-year-old woman, complaining of leg pain and unsteady gait for 3 years, presented with a spastic paraparetic gait, severe spasticity and touch, thermal and pain sensory loss limited to arms, lower thorax and upper abdomen. Brain and spinal cord magnetic resonance imaging showed a large loculated syrinx. Cerebellar tonsillar herniation into the foramen magnum was also seen (Arnold-Chiari malformation, type I). OUTCOME: The patient had successful cervico-spinal surgical decompression which resulted in marked reduction in hypertonia and weakness, normal gait and normal joint movement at 6 months. CONCLUSION: This unusual, late clinical presentation of a congenital disease underlines the importance of a comprehensive diagnostic work-up in the elderly patients with complex neurological signs.

Age of Onset↗