Disclosures: Andrew R. Minkley, MD: No financial relationships or conflicts of interest

Case Description: 41-year-old male with a 23-year history of incomplete lumbar paraplegia presenting with progressive sensory and motor deficits, urinary retention, dysphagia and diplopia whose symptoms initially started 15 years prior to presentation.

Setting: Tertiary Care Center

Patient: 41-year-old male with L2 ASIA impairment scale (AIS) D spinal cord injury secondary to a gunshot wound Assessment/

Results: MRI of the brain was unremarkable, with no evidence of infarction, Chiari malformation or hydrocephalus. However, MRI of the entire spine demonstrated a holocord syrinx extending from the medulla through the conus at L2-3. A videofluoroscopic swallow study showed mild pharyngeal dysphagia without evidence of aspiration. Despite a successful syringosubarachnoid shunt placement and subsequent inpatient rehabilitation stay, the patient did not show any significant return of motor or sensory function, though he did report subjective improvement in his swallowing function. ISNCSCI was C1 AIS D at the time of discharge from rehabilitation.

Discussion: Post-traumatic syringomyelia is a well-recognized late complication of spinal cord injury, with an estimated prevalence of over 50% in all spinal cord injury cases. Symptomatic syringomyelia only presents in 1-7% of cases, and holocord involvement of the syrinx occurs even more rarely, with only a few cases reported in the literature. Here we present a rare case of holocord syringomyelia with bulbar involvement.

Conclusion: Timely recognition of the signs and symptoms of progressive syringomyelia is important to prevent extensive and potentially irreversible neurologic damage, particularly in those demonstrating bulbar dysfunction and signs of holocord involvement. Clinicians must remain vigilant when working up new neurologic deficits in a patient with distant spinal cord injury.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/holocord-post-traumatic-syringomyelia-presenting-with-bulbar-involvement-a-case-report/