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Syringomyelia presenting as ulnar neuropathy at the elbow
1Department of Neurology, Beth Israel Medical Center, NY, New York, USA. sscelsa@bethisraelny.org
Summary
Syringomyelia, a condition associated with Chiari malformation type 1, can mimic ulnar neuropathy at the elbow. This case highlights the importance of considering syringomyelia in patients with atypical nerve disorder symptoms.
Area of Science:
- Neurology
- Neurosurgery
- Clinical Neuroscience
Background:
- Syringomyelia, often associated with Chiari malformation type 1 (CM1), can present with complex neurological deficits.
- Unilateral muscle involvement and dissociated sensory loss are characteristic but can be confusing.
- Differential diagnosis is crucial, especially when symptoms suggest peripheral nerve entrapment.
Purpose of the Study:
- To report a case of CM1 and syringomyelia with an unusual presentation.
- To illustrate how syringomyelia can mimic ulnar neuropathy at the elbow.
- To emphasize the diagnostic challenges in neurosurgical conditions.
Main Methods:
- Case report of a 24-year-old woman.
- Clinical examination including assessment of muscle atrophy and weakness.
- Nerve conduction studies (NCS) and electromyography (EMG).
- Magnetic resonance imaging (MRI) of the cervical spine.
Main Results:
- The patient presented with symptoms suggestive of ulnar neuropathy at the elbow, including disproportionate abductor digiti mini (ADM) atrophy and weakness.
- NCS showed reduced ADM-compound muscle action potential (CMAP) amplitude without focal slowing or block.
- EMG revealed multi-segmental denervation changes, and MRI confirmed CM1 and syringomyelia.
Conclusions:
- Syringomyelia can present with symptoms that clinically mimic ulnar neuropathy at the elbow.
- This case underscores the need for a broad differential diagnosis in neurological presentations.
- Comprehensive neurophysiological and imaging studies are essential for accurate diagnosis.