Disclosures: Michael V. Nguyen, MD, MPH: No financial relationships or conflicts of interest

Case Description: Initial symptoms consisted of fatigue and mild weakness with limited activity. This gradually progressed to decreased hand grip and slowed gait. Unknowingly, she adapted to these changes. Over a 24-month period, she sustained a mechanical fall, reported right upper extremity dysesthesia, and developed left shoulder pain. MRI with contrast demonstrated extensive C1-2 through T2-3 diffuse intramedullary hyperintensity and central hypointensity. Findings were suggestive of a large cervicothoracic syrinx, measuring 1.1×1.5 centimeters in the axial plane at C6-C7 and near obliteration of the spinal cord. Physical Therapy and Occupational Therapy did not abate progressive neurologic deterioration. Symptoms progressed causing loss of left shoulder abduction and of left ankle dorsiflexion, dysesthesia throughout her bilateral upper extremities, and decreased dexterity. Given functional limitations, patient underwent syringosubarachnoid shunt placement to stop tetraparesis progression.

Setting: Acute Inpatient Rehabilitation

Patient: A 81 year old female with progressive tetraparesis Assessment/

Results: Post-operatively, patient demonstrated gradual improvement of tetraparesis.

Discussion: Etiology of syringomyelia can be congenital, acquired, or idiopathic. Congenital causes are commonly associated with Chiari malformation type 1, which generally presents during early adulthood. Given patient’s presentation, this is unlikely. Based on imaging, we identified multiple loculated fluid pockets within her syringomyelia, suggesting chronicity. Given no prior imaging, her etiology was deemed idiopathic. This case shows how a patient with severe spinal cord disease can continue to perform activities of daily living and instrumental activities of daily living with personal adaptations and modified independence. While functional loss was originally attributed to aging, we suspect spinal compression reached a threshold, where neurological deficits negatively impacted function.

Conclusion: Neurological changes are common with aging. When the answer does not account for the presentation, further work-up is required. Because there was not a broad differential diagnosis, the diagnosis of a large syringomyelia was delayed. This highlights the importance of history in identifying the etiology of neurological decline.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/insidious-onset-of-cervicothoracic-syringomyelia-a-case-report/