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Journal of Medical Case Reports
Published in: Journal of Medical Case Reports 1/2020

Open Access 01-12-2020 | Magnetic Resonance Imaging | Case report

Development of pre-syrinx state and syringomyelia following a minor injury: a case report

Authors: Andrea Kleindienst, Tobias Engelhorn, Verena Roeckelein, Michael Buchfelder

Published in: Journal of Medical Case Reports | Issue 1/2020

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Abstract

Background

A generally accepted rule is that posttraumatic syringomyelia (PTS) results from spinal cord injury (SCI).

Case presentation

Here, we report the development of syringomyelia without SCI in a 54-year-old Caucasian man following a mild motor vehicle accident. The computed tomography on admission excluded an injury of the spine. Because of neck and back pain, magnetic resonance imaging was performed on day 3 post-injury and demonstrated minimal changes from a ligamentous strain at the cervicothoracic transition. Any traumatic affection of the bone, vertebral discs, intraspinal compartment, or spinal cord were excluded. Some limb weakness and neurogenic bladder dysfunction started manifesting within the following weeks. Repeated MRIs following the accident demonstrated arachnoid adhesions at the C1–2 level and spinal cord edema equivalent to a pre-syrinx state at 12 months and syrinx formation at 24 months. Because of further deterioration, decompression was performed at 36 months.

Conclusions

We conclude that even after a minor trauma PTS can occur and that medullary edema (pre-syrinx state) may precede syrinx formation.
Literature
1.
Milhorat TH, Johnson RW, Milhorat RH, Capocelli AL Jr, Pevsner PH. Clinicopathological correlations in syringomyelia using axial magnetic resonance imaging. Neurosurgery. 1995;37(2):206–13.PubMed
2.
Fairholm DJ, Turnbull IM. Microangiographic study of experimental spinal cord injuries. J Neurosurg. 1971;35(3):277–86.PubMed
3.
Cho KH, Iwasaki Y, Imamura H, Hida K, Abe H. Experimental model of posttraumatic syringomyelia: the role of adhesive arachnoiditis in syrinx formation. J Neurosurg. 1994;80(1):133–9.PubMed
4.
Abel R, Gerner HJ, Smit C, Meiners T. Residual deformity of the spinal canal in patients with traumatic paraplegia and secondary changes of the spinal cord. Spinal Cord. 1999;37(1):14–9.PubMed
5.
Perrouin-Verbe B, Robert R, Lefort M, Agakhani N, Tadie M, Mathe JF. Post-traumatic syringomyelia. Neurochirurgie. 1999;45(Suppl 1):58–66.PubMed
6.
Elliott NS, Lockerby DA, Brodbelt AR. A lumped-parameter model of the cerebrospinal system for investigating arterial-driven flow in posttraumatic syringomyelia. Med Eng Phys. 2011;33(7):874–82.PubMed
7.
Fischbein NJ, Dillon WP, Cobbs C, Weinstein PR. The “presyrinx” state: a reversible myelopathic condition that may precede syringomyelia. Am J Neuroradiol. 1999;20(1):7–20.PubMed
8.
Bozzo A, Marcoux J, Radhakrishna M, Pelletier J, Goulet B. The role of magnetic resonance imaging in the management of acute spinal cord injury. J Neurotrauma. 2011;28(8):1401–11.PubMedPubMedCentral
9.
Aebli N, Ruegg TB, Wicki AG, Petrou N, Krebs J. Predicting the risk and severity of acute spinal cord injury after a minor trauma to the cervical spine. Spine J. 2013;13(6):597–604.PubMed
10.
Martin AR, De Leener B, Cohen-Adad J, Cadotte DW, Kalsi-Ryan S, Lange SF, et al. Clinically feasible microstructural MRI to quantify cervical spinal cord tissue injury using DTI, MT, and T2*-weighted imaging: assessment of normative data and reliability. AJNR Am J Neuroradiol. 2017;38(6):1257–65.PubMed
11.
Elrai S, Souei Mhiri M, Arifa Achour N, Mrad Daly K, Ben Hmida R, Jemni Gharbi H, et al. MR imaging in spinal cord injury. J Radiol. 2006;87(2 Pt 1):121–6.PubMed
12.
Machino M, Ando K, Kobayashi K, Ota K, Morozumi M, Tanaka S, et al. MR T2 image classification in adult patients of cervical spinal cord injury without radiographic abnormality: a predictor of surgical outcome. Clin Neurol Neurosurg. 2019;177:1–5.PubMed
13.
14.
Lyons BM, Brown DJ, Calvert JM, Woodward JM, Wriedt CH. The diagnosis and management of post traumatic syringomyelia. Paraplegia. 1987;25(4):340–50.PubMed
15.
Vernon JD, Silver JR, Ohry A. Post-traumatic syringomyelia. Paraplegia. 1982;20(6):339–64.PubMed
16.
Umbach I, Heilporn A. Review article: post-spinal cord injury syringomyelia. Paraplegia. 1991;29(4):219–21.PubMed
17.
Biyani A, el Masry WS. Post-traumatic syringomyelia: a review of the literature. Paraplegia. 1994;32(11):723–31.PubMed
18.
Zhang C, Chen K, Han X, Fu J, Douglas P, Morozova AY, et al. Diffusion tensor imaging in diagnosis of post-traumatic syringomyelia in spinal cord injury in rats. Med Sci Monit. 2018;24:177–82.PubMedPubMedCentral
19.
Brodbelt AR, Stoodley MA. Post-traumatic syringomyelia: a review. J Clin Neurosci. 2003;10(4):401–8.PubMed
20.
el Masry WS, Biyani A. Incidence, management, and outcome of post-traumatic syringomyelia. In memory of Mr Bernard Williams. J Neurol Neurosurg Psychiatry. 1996;60(2):141–6.PubMedPubMedCentral
21.
Kleindienst A, Laut FM, Roeckelein V, Buchfelder M, Dodoo-Schittko F. Treatment of posttraumatic syringomyelia: evidence from a systematic review. Acta Neurochir. 2020;162:2541–56.PubMed
22.
Bonfield CM, Levi AD, Arnold PM, Okonkwo DO. Surgical management of post-traumatic syringomyelia. Spine (Phila Pa 1976). 2010;35(21):S245–58.
23.
Shannon N, Symon L, Logue V, Cull D, Kang J, Kendall B. Clinical features, investigation and treatment of post-traumatic syringomyelia. J Neurol Neurosurg Psychiatry. 1981;44(1):35–42.PubMedPubMedCentral
24.
Vernon JD, Silver JR, Symon L. Post-traumatic syringomyelia: the results of surgery. Paraplegia. 1983;21(1):37–46.PubMed
25.
Suzuki M, Davis C, Symon L, Gentili F. Syringoperitoneal shunt for treatment of cord cavitation. J Neurol Neurosurg Psychiatry. 1985;48(7):620–7.PubMedPubMedCentral
26.
Vaquero J, Martinez R, Salazar J, Santos H. Syringosubarachnoid shunt for treatment of syringomyelia. Acta Neurochir. 1987;84(3–4):105–9.PubMed
27.
Padovani R, Cavallo M, Gaist G. Surgical treatment of syringomyelia: favorable results with syringosubarachnoid shunting. Surg Neurol. 1989;32(3):173–80.PubMed
28.
Wiart L, Dautheribes M, Pointillart V, Gaujard E, Petit H, Barat M. Mean term follow-up of a series of post-traumatic syringomyelia patients after syringo-peritoneal shunting. Paraplegia. 1995;33(5):241–5.PubMed
29.
Lam S, Batzdorf U, Bergsneider M. Thecal shunt placement for treatment of obstructive primary syringomyelia. J Neurosurg Spine. 2008;9(6):581–8.PubMed
30.
Hida K, Iwasaki Y, Imamura H, Abe H. Posttraumatic syringomyelia: its characteristic magnetic resonance imaging findings and surgical management. Neurosurgery. 1994;35(5):886–91 (discussion 91).PubMed
31.
Cacciola F, Capozza M, Perrini P, Benedetto N, Di Lorenzo N. Syringopleural shunt as a rescue procedure in patients with syringomyelia refractory to restoration of cerebrospinal fluid flow. Neurosurgery. 2009;65(3):471–6 (discussion 6).PubMed
32.
Asano M, Fujiwara K, Yonenobu K, Hiroshima K. Post-traumatic syringomyelia. Spine (Phila Pa 1976). 1996;21(12):1446–53.
33.
Anton HA, Schweigel JF. Posttraumatic syringomyelia: the British Columbia experience. Spine (Phila Pa 1976). 1986;11(9):865–8.
34.
Lee TT, Arias JM, Andrus HL, Quencer RM, Falcone SF, Green BA. Progressive posttraumatic myelomalacic myelopathy: treatment with untethering and expansive duraplasty. J Neurosurg. 1997;86(4):624–8.PubMed
35.
Lee TT, Alameda GJ, Gromelski EB, Green BA. Outcome after surgical treatment of progressive posttraumatic cystic myelopathy. J Neurosurg. 2000;92(2 Suppl):149–54.PubMed
36.
Falci SP, Indeck C, Lammertse DP. Posttraumatic spinal cord tethering and syringomyelia: surgical treatment and long-term outcome. J Neurosurg Spine. 2009;11(4):445–60.PubMed
37.
Sgouros S, Williams B. A critical appraisal of drainage in syringomyelia. J Neurosurg. 1995;82(1):1–10.PubMed
38.
Lee TT, Alameda GJ, Camilo E, Green BA. Surgical treatment of post-traumatic myelopathy associated with syringomyelia. Spine (Phila Pa 1976). 2001;26(24 Suppl):S119–27.
39.
Milhorat TH, Johnson WD, Miller JI. Syrinx shunt to posterior fossa cisterns (syringocisternostomy) for bypassing obstructions of upper cervical theca. J Neurosurg. 1992;77(6):871–4.PubMed
40.
Edgar R, Quail P. Progressive post-traumatic cystic and non-cystic myelopathy. Br J Neurosurg. 1994;8(1):7–22.PubMed
41.
Ronen J, Catz A, Spasser R, Gepstein R. The treatment dilemma in post-traumatic syringomyelia. Disabil Rehabil. 1999;21(9):455–7.PubMed
Metadata
Title
Development of pre-syrinx state and syringomyelia following a minor injury: a case report
Authors
Andrea Kleindienst
Tobias Engelhorn
Verena Roeckelein
Michael Buchfelder
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2020
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-020-02568-6

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