[Type II split cord malformation of late clinical onset]

Area of Science:

• Neurology
• Neurosurgery
• Developmental Biology

Background:

• Split cord malformation (SCM) comprises SCM type I (diplomyelia) and SCM type II (diastematomyelia).
• These congenital anomalies are typically diagnosed in infancy or early childhood.
• Late-onset SCM is exceptionally rare, posing diagnostic challenges in adults.

Observation:

• A 68-year-old male presented with chronic radicular pain, sensory disturbances, and neurological deficits.
• Physical examination revealed left-sided proprioceptive symptoms, a left pyramidal syndrome, and a sacral pilonidal sinus.
• MRI demonstrated spinal cord duplication within a single dural tube at L2, indicative of SCM type II, with associated low conus medullaris and syringomyelia.

Findings:

• The patient's symptoms were attributed to a rare adult presentation of split cord malformation type II.
• The imaging findings included diplomyelia, low conus medullaris, and syringomyelia.
• This case underscores the possibility of late diagnosis for congenital spinal anomalies.

Implications:

• Advances in noninvasive spinal cord imaging may lead to more frequent adult diagnoses of SCM.
• Understanding rare congenital spinal conditions is crucial for accurate diagnosis and management in adult patients.
• This case expands the clinical spectrum of SCM presentation and diagnostic considerations.