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Two differential cavities in syringomyelia of pediatric Chiari I malformation presenting with unilateral foot drop.

Two differential cavities in syringomyelia of pediatric Chiari I malformation presenting with unilateral foot drop.

Authors :
Higuchi N
Nakamura T
Yoshioka F
Sanefuji M
Matsuo M
Source :
Brain & development [Brain Dev] 2023 Mar; Vol. 45 (3), pp. 191-195. Date of Electronic Publication: 2022 Dec 16.
Publication Year :
2023

Abstract

Introduction: Patients with Chiari I malformation (CM1) may have chronic symptoms of syringomyelia, including numbness and weakness of the upper limbs, typically during young adulthood. Acute or subacute presentation of unilateral foot drop has been rarely reported as a first symptom of CM1-associated syringomyelia exclusively in childhood or adolescence. Why these patients do not show any symptoms of the upper limbs although holocord syringomyelia is always observed on magnetic resonance imaging (MRI) is unclear.<br />Case Presentation: A four-year-old girl presented rapidly with isolated left foot drop. Conventional MRI revealed holocord syringomyelia associated with CM1. Three-dimensional constructive interference in steady state (3D-CISS) imaging further demonstrated that the syringomyelia was comprised of two differential cavities that communicated with each other via a small pore: a centrally positioned upper cavity and a left-deviated lower one. Surgical decompression of the foramen magnum resolved the symptom with radiological improvement of the two cavities.<br />Conclusion: In contrast to a centrally enlarged syrinx that is often asymptomatic, a paracentrally extended syrinx usually produces segmental signs related to its levels. Thus, the left foot drop in this case would have been due to the ipsilaterally deviated lower cavity that was distinguished from the central upper cavity by 3D-CISS imaging. Further reports using this imaging technique are needed to verify the hypothetic pathology.<br />Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.<br /> (Copyright © 2023 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)

Details

Language :
English
ISSN :
1872-7131
Volume :
45
Issue :
3
Database :
MEDLINE
Journal :
Brain & development
Publication Type :
Report
Accession number :
36529612
Full Text :
https://doi.org/10.1016/j.braindev.2022.11.007