Associate Professor Emory University Atlanta, Georgia, United States
Case Diagnosis: Post-traumatic syringomyelia with cervical radiculopathy
Case Description: 37-year-old male with history of TBI from bike versus MVA in 2021 with subsequent right SDH and SAH, as well as C2 fusion on 8/3/21 from polytrauma who presented to clinic originally with persistent left-hand weakness and scapular winging. Followingoutside electrodiagnostic testing performed in 2021, repeat testing in February 2024 demonstratedleft ulnar neuropathy at the elbow and left chronic, active C4/C5 cervical radiculopathy. However, thepatient returned to clinic in July 2024 for ongoing bilateral hand weakness which had progressed over the previous 5 weeks. Repeat electrodiagnostic testing suggested bilateral subacute, active cervical radiculopathy localizing to the T1 more so than C8 nerve roots. Given the ongoing weakness, MRI of the cervical spine was ordered and demonstrated a large area of intramedullary cystic change spanning the entire length of the cervical spinal cord and into the thoracic spinal cord, consistent with a spinal cord syrinx.
Discussions: Post-traumatic syringomyelia is an uncommon but important complication following a traumatic brain injury, developing in anywhere from 1-7% of patients. The timeline for presentation variesanywhere from months to decades after the initial injury. Acquired Chiari malformation in association with post-traumatichydrocephalus can contribute to syrinx development, which was confirmed in thispatient following further brain and head imaging. For patients with complex medical histories demonstrating neurological deficits, it is important to keep a broad differential for both central and peripheral causes for new or progressing symptoms. In this case, identifying the progressing lower motor neuron weakness guided further advanced imaging and diagnosis of the syrinx.
Conclusions: Post-traumatic complications of traumatic brain injuries present with many signs and symptoms, and syringomyelia is one complication that can manifest months to years after the original injury. Early identification of neurological changes guides further clinical decision-making and allows for intervention.
