Syringomyelia in a patient with concurrent post-traumatic hydrocephalus and tethered spinal cord: implications for surgical management.

BACKGROUND: Posttraumatic syringomyelia is a significant source of disability following spinal cord injury (SCI). Despite this, its etiology and optimal treatment remain controversial. Early identification of and intervention at a presyrinx state may halt progression. Here, we present a unique case illustrating the continuum between presyrinx and syrinx in an adult following severe distraction cervical SCI and traumatic brain injury, resulting in both tethered spinal cord and posttraumatic hydrocephalus and subsequent isolated fourth ventricle. The interplay between these etiologic factors and their therapeutic implications are discussed. CASE DESCRIPTION: A 48-year-old female developed rapidly progressive cervical spinal cord edema and hydromyelia almost 6 months after severe SCI and traumatic brain injury, with an initial Glasgow Coma Scale score of 3. Imaging demonstrated both ventral tethering of her cord at the site of injury (C5/6), as well as a trapped fourth ventricle following lateral ventricular shunting for posttraumatic hydrocephalus, with diminished flow of cerebrospinal fluid at the craniocervical junction. Additional shunting of the fourth ventricle led to significant clinical improvement and dramatic radiologic regression of her cord abnormality. CONCLUSIONS: Cognizance of the possible presence of multiple etiologic contributors to posttraumatic syringomyelia and an intricate understanding of their interplay are crucial to the optimal management of this complex pathology.