Case ReportAcute cervical cord syrinx after aneurysmal subarachnoid haemorrhage
Introduction
A syrinx describes cystic cavitation of the spinal cord and syringomyelia the resulting disease concept [1]. This process is associated with acquired or congenital abnormalities along the spinal neuraxis, typically at the craniocervical junction. The clinical spectrum of syringomyelia ranges from asymptomatic radiological abnormality to quadraplegia.
Currently, no unifying theory exists to explain the pathophysiology of this condition. As our understanding of cerebrospinal fluid (CSF) dynamics matures, so do theories explaining pathological states such as syrinx [2]. Theories pertaining to the formation of syrinx are discussed with reference to the current case.
Section snippets
Case report
A 70-year-old woman with a history of hypertension, type 2 diabetes, and hypercholesterolaemia presented with sudden onset severe headache. Her Glasgow Coma Scale score was 15 with no focal deficits (World Federation of Neurosurgical Societies Grade I). CT brain demonstrated subarachnoid and intraventricular blood (Modified Fisher Grade IV). There was no significant hydrocephalus. Cerebral digital subtraction angiography revealed a 1.3 mm anterior communicating artery aneurysm (AcommA) not
Discussion
Despite a plethora of hypotheses to explain the pathophysiology underlying syrinx formation, a unifying theory does not exist. Various theories describe abnormal fluid mechanics that lead to either CSF being diverted from the fourth ventricle down the central canal, CSF moving from the spinal subarachnoid space to the syrinx or interstitial fluid accumulating within the cord forming the syrinx [3], [4], [5], [6].
Classic theories which center on the diversion of CSF through the central canal
Conflicts of Interest/Disclosures
The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
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Cited by (1)
Syringomyelia in Patient with Concurrent Posttraumatic Hydrocephalus and Tethered Spinal Cord: Implications for Surgical Management
2020, World NeurosurgeryCitation Excerpt :Our current practice includes the insertion of a thin layer of human amniotic membrane into the subdural space before closure to decrease the risk of scarring and retethering19 and, in cases requiring cyst diversion, placing the distal catheter into the peritoneum to optimize long-term patency, especially in patients with confluent arachnoid adhesions. An association between hydrocephalus and syringomyelia was reported in the 1920s3 and has since expanded to encompass congenital, as well as acquired hydrocephalic etiologies including SAH,20,21 intraventricular hemorrhage of prematurity,22 tumor,23,24 infection,25,26 trauma,27,28 and basilar invagination.29 This lends support to the Gardner and Williams theories of communicating syringomyelia,30 and is usually responsive to shunting of the lateral ventricular system, though successful outcome in select cases following endoscopic third ventriculostomy23,31,32 and posterior fossa decompression33 have also been reported.