Megan Craig, DO
Resident Physician
UCF/HCA Florida West Hospital
Cantonment, Florida, United States
Justin Buck, DO
Resident Physician
UCF/HCA Florida West Hospital
Pensacola, Florida, United States
Kristina Ledbetter, DO
Resident Physician
UCF/HCA Florida West Hospital
Clearwater, Florida, United States
Mathew McGillivray, MD
Resident Physician
UCF/HCA Florida West Hospital
Pensacola, Florida, United States
Zachary Lin, DO
Resident Physician
UCF/HCA Florida West Hospital
Pensacola, Florida, United States
Joseph Cahill, MD
Attending Physician / Neurologist
UCF/HCA Florida West Hospital
Pensacola, Florida, United States
Jeff Buchalter, MD
Attending Physician
UCF/HCA Florida West Hospital
Pensacola, Florida, United States
Holocord syringomyelia with right common peroneal neuropathy
Case Description:
We present a case of a 48-year-old woman with Chiari I malformation, experiencing rapidly worsening sensory disturbance and weakness in all extremities over a year. Physical examination indicated peripheral neuropathy, with reduced pain and temperature sensation mainly in the hands and feet, and flaccid weakness in right foot. A positive Hoffman sign was the lone finding on clinical exam suggesting central nervous system involvement. MRI of the cervical and lumbar spine revealed a holocord syrinx from the cervical spine to the conus, prompted by the isolated upper motor neuron finding. Electrodiagnostic testing confirmed a subacute right common peroneal neuropathy. Urgent neurosurgical intervention with suboccipital decompression and C1 laminectomy followed by rehabilitation was successful. Four months post-operation, despite rehabilitation efforts, the patient demonstrated persistent right foot drop and weakness in the distal upper extremities. Ambulation remained challenging, necessitating the use of a walker.
Discussions: Holocord involvement in Syringomyelia, a condition characterized by the development of fluid-filled cavities within the spinal cord is rare and can often manifest with clinical features resembling both central cord lesion and peripheral nervous system pathology posing diagnostic challenges for the clinician. We present an unusual case of Syringomyelia with holocord involvement and atypical clinical exam findings.
Conclusions:
This case stresses the importance of including syringomyelia in the diagnosis of neuropathic symptoms, especially with Chiari I malformation and indications of central nervous system involvement. It emphasizes the necessity of a comprehensive diagnostic process, including thorough neurological examinations and neuroimaging, to guide proper treatment and prevent irreversible neurological damage. The discovery of an abnormal reflex in the upper extremity played a crucial role in selecting the appropriate diagnostic test, potentially averting delays in diagnosis of months to years.
