Disclosures: Tomas W. Salazar, MD: Nothing to disclose

Case Description: This patient is a 59-year-old man who presented to an acute care hospital for elective surgery of a spinal cord syrinx. About 1 year prior to surgery, he started having bilateral lower extremity paresthesias, along with stiffness, tightness, and weakness below the knees. At first, he was diagnosed with medial tibial stress syndrome. He developed further sensory changes from his left waist to his thigh. He was prescribed outpatient physical therapy for about 1 month without improvement and was using a cane for ambulation. Spinal magnetic resonance imaging (MRI) was later performed, demonstrating a large syrinx from C5 to T7; Chiari malformation, tethered cord, and tumor were ruled out. He underwent a successful T2-T3 laminectomy with syringo-subarachnoid shunt placement.

Setting: Academic acute inpatient rehabilitation hospital.

Patient: A 59-year-old male diagnosed with an idiopathic syringomyelia.

Assessment/Results: Upon admission to an acute rehabilitation hospital, he had T6 ASIA Impairment Scale (AIS) D paraplegia and required minimum assist/contact guard assist for transfers, ambulation, and activities of daily living (ADLs). With comprehensive therapy, he progressed to supervision/independent for ADLs and transfers and modified independent for ambulation with a rolling walker.

Discussion: Syringomyelia are typically associated with other neurological abnormalities such as Chiari malformation, tethered cord syndrome, or spinal cord injury. This isolated case of syringomyelia is unique, especially given its rarity in the older adult population. Further, his initial presentation involved only the lower extremities with symptoms of pain, while syringomyelia classically starts with loss of pinprick and temperature sensation in a cape-like distribution.

Conclusion: Syringomyelia in patients without predisposing neurological malformations can be difficult to diagnose without imaging. They can present outside the typical age bracket and with symptoms that vary from the normal presentation. However, with proper surgical intervention and a comprehensive rehabilitation program, patients can make substantial gains in functionality.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-idiopathic-syringomyelia-in-a-59-year-old-man-presenting-with-lower-extremity-symptoms-a-case-report/