MyPACS.net: Radiology Teaching Files > Case 3384852

previously visited SYRINX- CERVICAL CORD
Contributed by: Fritsch & Thompson.
Patient: 39 year old male
History: 39 yr. old male with history of previous trauma resulting in paraplegia
Images:[small]larger

Fig. 1: Lateral cervical spine radiograph.

Fig. 2: AP cervical film shows broad laminectomy defect of upper thoracic spine

Fig. 3: T1 sagittal- central low signal mass extending over multiple levels in central cord

Fig. 4: T1 sagittal- central low signal mass extending over multiple levels in central cord. Upper thoracic gibbus from earlier compression fracture T3

Fig. 5: T2 image- Central mass with bright signal, consistent with fluid. Upper thoracic gibbus from earlier compression fracture T3

Fig. 6: T2 image- Central mass with bright signal, consistent with fluid. Upper thoracic gibbus from earlier compression fracture T3

Fig. 7: T2 image- Central mass with bright signal, consistent with fluid

Fig. 8: T2 image- Central mass with bright signal, consistent with fluid

Fig. 9: T2 image- Central mass with bright signal, consistent with fluid

Fig. 10: T1 sagittal post-gadolinium showing no contrast enhancement

Fig. 11: T1 sagittal post-gadolinium showing no contrast enhancement

Fig. 12: T1 axial post-gadolinium showing no contrast enhancement

Fig. 13: T1 axial post-gadolinium showing no contrast enhancement

Fig. 14: T1 axial post-gadolinium showing no contrast enhancement

Fig. 15: Schematic diagram illustring syrinx

Fig. 16: Drawing of syrinx
Findings:
  • Sagittal images show compression defomrity of T3 with complete interruption of cord integrity, compatible with patient's history of traumatic paraplegia.
  • Multi-level, lobulated intramedullary mass with fluid signal characteristics extends rostrally from the site of cord trauma.
  • Hypointense T1, hyperintense T2, non-enhancing post-gadolinium characteristics are indicative of fluid (CSF) accumulation within the spinal cord.
Diagnosis: Syringomyelia secondary to prior spinal cord trauma
Discussion:

  • Etiologies for syrinx formation in the cord include:
    • congenital anomalies of the atlanto-occipital area (eg, Arnold-Chiari malformation, 4th ventricle obstruction, basilar impression)
    • hydrocephalus
    • posttraumatic
    • tumor related
    • arachnoiditis related
    • idiopathic.
  • The incidence of syringomyelia above the spinal fracture site is approximately 3-5%.
    Posttraumatic syringomyelia may develop after either severe or relatively minor spinal cord injury. Enlarging posttraumatic syringomyelia is manifested clinically by a progressive neurologic deficit that extends some distance above the initial site of injury. 
  • The clinical problem develops months to many years after the initial
    injury and typically produces dissociated sensory deficit (loss of
    pain/temperature in a bilateral "cape-like" distribution due to
    interruption of the anterior white commisure of the anterolateral
    system); motor signs (upper motor neuron) may occur later if pressure
    on the corticospinal tract occurs.
References:

patient referred by Drs. Mary Doyle and Ed Kieke

Emedicine
website paper. Authored by: Farhood Saremi, MD, Associate Professor of
Radiology, University of California, Irvine College of Medicine;
Coauthor(s): Chi-Shing Zee, MD, Chief of Neuroradiology, Professor,
Departments of Radiology and Neurosurgery, University of Southern
California School of Medicine; John L Go, MD, Assistant Professor,
Department of Radiology, Section of Neuroradiology, Keck School of
Medicine, University of Southern California Medical Center

Case Of the Week: 12/21/2005

MRI Case of the Week: 8/30/06

Comments:
Posttraumatic syringomyelia may develop months to years after the initial injury. It is thought to arise from a combination of myelomalacia and diversion of CSF dynamics from the central canal. MRI (with and without contrast of the entire spine) is the diagnostic modality of choice. This would rule out tumor and infectious etiologies, as well as congenital etiologies such as spinal dysraphisms. Surgical treatment is warranted when symptomatic. Syringo-arachnoid shunt via laminectomies at the level of the syrinx can be done. Intraoperative ultrasound, microscope, and SSEP should be utilized. If possible, microsurgical release of the arachnoid adhesions at the level of the presumed CSF outflow obstruction would increase successful results and prevention of recurrence. Peter J. Yeh, MD. Gulfcoastbrainandspine.com.--Peter Yeh, 2005-12-21
Additional Details:

Case Number: 3384852Last Updated: 08-16-2006
Anatomy: Spine and Peripheral Nervous System   Pathology: Benign Mass, Cyst
Modality: Conventional Radiograph, MRAccess Level: Readable by all users
Keywords: syrinx; cervical cord; syringomyelia

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