Multiple sclerosis with secondary syringomyelia. An autopsy report

Area of Science:

• Neurology
• Pathology
• Radiology

Background:

• Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
• Spinal cord involvement in MS can manifest in various ways, including demyelination and lesion formation.
• Syringomyelia, the formation of cavities within the spinal cord, is a rare complication.

Observation:

• An elderly female patient with a confirmed diagnosis of multiple sclerosis presented with extensive cavity formation in the midthoracic spinal cord.
• Magnetic resonance imaging (MRI) revealed multiple abnormal intensity signals throughout the central nervous system.
• The patient experienced neurological symptom exacerbations potentially linked to the spinal cord cavity.

Findings:

• The spinal cord cavity showed a significant decrease in size following corticosteroid therapy.
• Neurological symptoms improved concurrently with the reduction in cavity size.
• Autopsy confirmed a slit-like cavity in the lower cervical to midthoracic cord, characterized by demyelinative lesions and lacking ependymal cells, consistent with secondary syringomyelia.

Implications:

• This case highlights a potential pathway for secondary syringomyelia development in multiple sclerosis patients, possibly originating from localized spinal cord necrosis.
• Corticosteroid therapy may be beneficial in managing spinal cord cavity formation and associated neurological deficits in MS.
• Further research is warranted to elucidate the precise mechanisms linking MS, spinal cord necrosis, and syringomyelia.