Disclosures: Thai H Vu, DO: Nothing to disclose

Case Description: The patient presented for evaluation of chronic neck pain that had progressively worsened over a year. She described the pain as achy with intermittent burning into her left shoulder. She reported accompanying episodes of shooting pain into her arms and fluctuating imbalance. Otherwise, she denied bowel/bladder dysfunction, saddle anesthesia, nocturnal pain, night sweats, or IV drug use. To note, a prior trial of physical therapy had exacerbated her pain, which prompted her to start working with a chiropractor. During one chiropractic session, she started having significantly increased neck pain. She presented emergently to a hospital and underwent CTA head/neck for possible arterial dissection, but her work up was negative. Her examination revealed intact cranial nerves and light touch. She had asymmetric mixed hypo- and hyper-reflexia, positive Hoffmann, Babinski, and sustained clonus bilaterally. Her cervical spine had a normal alignment and a full range of motion except for restricted bilateral rotation. Left shoulder exam was unremarkable. Motor strength was 5/5 throughout except for 4/5 strength in bilateral APB and FDI. Spurling’s, Lhermitte’s, SLR, Slump tests were negative.

Setting: Sports Medicine Clinic

Patient: A 49-year-old woman with posterior neck pain with associated paresthesias and impaired balance.

Assessment/Results: Given her family history of multiple sclerosis, a full spine MRI was obtained, which demonstrated an expansile syrinx extending from the cervicomedullary junction to T11. Brain MRI revealed dilated lateral ventricles and the presence of a Chiari 1 malformation. She subsequently underwent a suboccipital decompression with C1 laminectomy and duraplasty.

Discussion This is an unusual case of neck pain, one of the most common diagnoses for physiatrists, found to be caused by a massive syringomyelia.

Conclusion : This case highlights the importance of comprehensive neuromuscular exams to appropriately identify deficits which can lead to not only an accurate diagnosis of more common causes of neck pain, but also rarer cases.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/atypical-neck-pain-from-a-syringomyelia-a-case-report/