[Syringomyelic syndrome secondary to cervical canal stenosis and cervical spondylosis]

A 59-year-old man suffered from progressive muscular weakness and sensory loss of both upper limbs for seven years. Neurological examination revealed vest-form sensory loss of all modalities from the level of C3 to Th2 on both sides together with muscular weakness and atrophy of the upper limbs in predominantly proximal distribution. Deep tendon reflexes were generally hyperactive except for the left biceps brachii. Based on these neurological manifestations, a clinical diagnosis of syringomyelic syndrome was made. The plain X-ray showed anomalies of the craniovertebral junction; occipitalization of the atlas, separate odontoid and fusion of C2 and C3 vertebrae, as well as cervical canal stenosis with cervical spondylosis. On sagittal T2-weighted MRI, the spinal cord was compressed at multiple levels from C3/4 to C6/7, and an intramedullary high signal intensity area was demonstrated from the level of C1 to C3/4. T1-weighted axial image showed a cavity formation at the center of the cord from the level of C1 to C2. No chiari malformation was found. Normal pulsatile CSF movement was diminished below the level of compression on cine MRI. On delayed CT examination 6 hr after myelography, the contrast medium was collected inside the spinal cord and showed "snake-eyes" appearance at and near the level of spondylosis. Above this level extending to C1, there was a longitudinally oriented "pencil-shape" zone of intramedullary contrast collection. These neuroimaging findings well corresponded with the patient's neurological signs and symptoms. The muscular weakness of both upper limbs improved after conservative therapy including immobilization of the neck position.(ABSTRACT TRUNCATED AT 250 WORDS)