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Fluid in the flute: Reversible hydromyelia

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Abstract

Non-communicating syrinx formation in association with demyelinating disease has been reported in approximately 50 patients. It has been unknown whether this is a permanent or potentially reversible phenomenon. We report a patient with acute transverse myelitis who developed a syrinx that resolved within 6 months. Mechanisms of syrinx formation in demyelinating disease are discussed.

Introduction

Syrinx cavities in the brainstem or spinal cord can be divided into communicating and non-communicating forms. Non-communicating syrinx has been described in association with tumor, trauma, infection and inflammation of the spinal cord [1]. It has been uncertain whether cavities that form during intense intrathecal inflammation result from expansion of the central canal or tissue necrosis.

With the advent of magnetic resonance imaging (MRI), numerous patients with syrinx or hydromyelia and inflammatory central nervous system (CNS) disease have been described (reviewed in [2]).

Here we report a patient who, in the setting of acute transverse myelitis, developed hydromyelia that resolved almost completely within 6 months.

Section snippets

Case report

One week after a febrile upper respiratory illness, a 45-year-old Caucasian male presented with band-like chest pressure and acute urinary retention.

For years, the patient had experienced episodes of polyarthralgias with swelling of hand and finger joints, photosensitivity, as well as chest heaviness and dyspnea on exertion. A CT of the chest had demonstrated multifocal, predominantly peripheral opacities in both lungs, suggesting a chronic inflammatory process. Serologic testing for

Discussion

This report represents the first detailed account of reversible syrinx cavity formation, demonstrated with imaging studies, during an episode of acute myelitis. Fluctuating hydromyelia has been reported in Japanese patients with multiple sclerosis [2].

The relationship between inflammatory CNS disease and syringomyelia seems to be non-coincidental, and several mechanisms have been suggested to explain the formation of a syrinx in inflammatory CNS disease [2]:

  • a)

    Edema associated with inflammatory

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