Spinal syringomyelia following subarachnoid hemorrhage

Area of Science:

• Neurology
• Neurosurgery
• Spinal Cord Medicine

Background:

• Subarachnoid hemorrhage (SAH) is a known cause of chronic spinal arachnoiditis.
• Syringomyelia is typically associated with spinal arachnoiditis, but its occurrence after aneurysmal SAH is infrequently reported.

Observation:

• This study details two patients who developed syringomyelia secondary to chronic spinal arachnoiditis following aneurysmal SAH.
• The incidence of syringomyelia following aneurysmal SAH in this cohort was 1.0% (2 out of 198 patients).
• Clinical presentations included sensory disturbances, motor deficits, and cranial nerve palsies, with MRI confirming spinal cord syrinx formation.

Findings:

• Patient 1, a 54-year-old woman, presented with back pain, numbness, and gait disturbance 20 months post-SAH, showing syringomyelia from C2 to T10.
• Patient 2, a 49-year-old man, experienced headache, diplopia, hoarseness, dysphagia, and ataxia five months post-SAH, with syringomyelia from the medulla to C6 and ventricular enlargement.
• Both patients underwent surgical interventions, including shunting procedures and foramen magnum decompression with C1 laminectomy.

Implications:

• Spinal arachnoiditis and syringomyelia represent rare yet significant chronic complications after subarachnoid hemorrhage.
• These findings underscore the need for vigilance in monitoring patients post-SAH for the development of these neurological sequelae.
• Early diagnosis and appropriate management, including surgical intervention, are crucial for mitigating the long-term impact of syringomyelia following SAH.