Syringobulbia and Syringomyelia Associated with Intramedullary Ependymoma

No cases of bulbar palsy secondary to hemorrhage from intramedullary ependymoma into the peritumoral cavity have been reported. A 23-year-old man presented with persistent hiccups, pneumonia, and progressively worsening respiratory dysfunction. Clinical course and imaging findings raised strongly suggested bulbar palsy from a C4-5 intramedullary hemorrhagic lesion. Computed tomography and magnetic resonance imaging of the brain and cervical spine revealed an intramedullary mass at C4-5, accompanied by syringobulbia and syringomyelia, with signals extending from the lower medulla oblongata to the T1 spinal level. The patient underwent laminectomy, myelotomy, and microsurgical mass excision with intraoperative neurophysiological monitoring. Postoperative pathology confirmed the lesion as an ependymoma. Neurologic function improved steadily after surgery. Thus, central respiratory dysfunction should be considered in patients with severe pneumonia without underlying disease. Additionally, contrast-enhanced magnetic resonance imaging is essential for differential diagnosis in bulbar palsy cases.