Post-traumatic syringomyelia with holocord involvement: a case report

Holocord syringomyelia in 18 dogs

Holocord syringomyelia (HSM) is characterized by a continuous spinal cord cavitation along its entire length and is currently poorly documented in dogs. This retrospective multicentric case series investigates the clinical and MRI findings in 18 dogs with HSM. The median age at presentation was 82 months (range 9-108 months) and French Bulldogs were overrepresented (50%). Signs of myelopathy attributed to HSM were detected in 12 dogs (67%), spinal pain/paresthesia/allodynia in eight (44%), and four dogs (22%) had no HSM-associated signs. The most common neuroanatomical localization was C1-C5 spinal cord segments. On MRI, the cranial limit of HSM was at C1 vertebra in seven (39%) and at C2 in 11 dogs (61%). The caudal limit extended to L3 in four dogs (22%), L4 or L5 in six dogs (33%) each, and L6 in two dogs (11%). The conus medullaris terminated at L5 in one dog (6%), L6 in 11 (61%), and L7 in six dogs (33%). Seventeen dogs (94%) exhibited MRI features of Chiari-like and/or other intracranial/cranio-cervical junction malformations. One dog (6%) was treated surgically, 11 (61%) medically, and six (33%) received no treatment. Over a median follow-up of 12 months (range 2-65 months) in 16 dogs, one dog (6%) improved, nine (56%) deteriorated, four (25%) were static, and two (13%) remained free of HSM-associated signs. This is the first study to describe canine HSM, highlighting a possible breed predisposition in French Bulldogs. The frequent occurrence of myelopathy and disease progression underscores the need for further research into the underlying etiopathogenesis, natural disease evolution, and response to therapeutic interventions.

Silent post-traumatic syringomyelia and syringobulbia

INTRODUCTION

Post-traumatic syringomyelia is a complication of traumatic spinal cord injury consisting in the development of a cavity within the spinal cord. Once considered an uncommon complication, its diagnosis has increased due to increased attention and advances in medical technology. Common symptoms of the syrinx are a sensory loss of the dissociated type with pain and temperature loss and the preservation of fine touch and vibratory sensation. Eventually, a deterioration of motor function with muscle wasting may occur.

CASE PRESENTATION

We present the case of a 36-year-old woman who sustained a sport accident in 1996, resulting in AIS A, T7 paraplegia. She underwent a magnetic resonance imaging (MRI) examination because of neck and left shoulder pain that resolved after a short anti-inflammatory treatment. The MRI showed a large cavity involving the cord beneath T6 and the medulla. Septations were present at both the spinal cord and medulla levels. With regard to vertebral status, the MRI showed the presence of severe kyphosis at the fracture level together with spinal cord compression. The neurological examination was normal except for the pre-existing paraplegia and of a slight heat and pain sensation deficit in the C8 dermatome.

DISCUSSION

We discuss the need of regular follow-up examinations as even large syrines with involvement of the brainstem may be asymptomatic. We also discuss the possible pathogenetic factors including the type of treatment of the vertebral lesion.