[Sudden exacerbation in atypical syringomyelia with a unilateral superficial sensory disorders as the principal manifestation].
We report a 22 year-old woman with syringomyelia, who complained of a sudden abnormal sensation in the left neck and upper extremity after maintaining her neck in flexion for sometime. Neurologic examination revealed superficial hypesthesia on the left from C2 down, but normal motor function. The mode of onset in our patient was atypical. The clinical manifestations of syringomyelia are usually slowly progressive. On the basis of X-P film of the cervical spine and cranial MRI, a diagnosis of syringomyelia with Chiari malformation (type 1) was made. The syrinx cavity extended from C1 to L1. On the transaxial image of the cervical cord, the syrinx cavity was demonstrated in the posterior horn area ipsilateral to the sensory disturbance. The CSF flow-void sign was present in the syrinx cavity, probably reflecting pulsation of the syrinx fluid. An abnormally high signal intensity area adjacent to the syrinx cavity on T2-weighted sequences indicated damaged cord. We speculate that dynamic factors produced by neck flexion and fluid pulsation explain the sudden exacerbation in our patient.
Shiojiri
T
T
Department of Neurology, Musashino Red Cross Hospital, Tokyo, Japan.
Tsuchiya
K
K
Watahiki
S
S
D000328:Adult; D002555:Cerebrospinal Fluid / Q000502:physiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009068:Movement; D009333:Neck; D011673:Pulsatile Flow; D012678:Sensation Disorders / Q000209:etiology*; D013595:Syringomyelia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology