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[Syringomyelia appearing in a short term after brain abscess]
H Matsumoto1, O Masuo, T Kuwata
1Department of Neurological Surgery, Kokuho Hidaka General Hospital.
Abstract:
We describe a rare case of syringomyelia that developed within only 4 months after the cure of the focal cerebritis and abscess. An 18-year-old man who had suffered from meningitis and brain abscess 1.5 years before, presented with pain and sensory disturbance in his left shoulder. Magnetic resonance image (MRI) showed a syrinx formation extending from the upper cervical to the lower thoracic cord. Investigation by MRI during the course of the brain abscess had the appearance of posterior cerebellar arachnoid cyst 3 months after the onset of brain abscess and syrinx developed within 9 months. After posterior fossa decompression and reopening of the Magendie's foramen, his symptom and MRI abnormality improved after one month. In contrast to reported cases of syringomyelia following cerebritis, syrinx formation in our case appeared in relatively a short time. We speculated that basal arachnoiditis and the formation of posterior cerebellar arachnoid cyst caused syrinx formation in a short term after cerebritis.
Insights
This case study highlights rapid syringomyelia development post-cerebritis. A posterior cerebellar arachnoid cyst likely contributed to this rare condition
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Syringomyelia is a rare condition characterized by the development of a fluid-filled cyst (syrinx) within the spinal cord.
- Cerebritis, an inflammation of brain tissue, and brain abscesses are serious infections that can lead to neurological complications.
- The development of syringomyelia following cerebritis is uncommon, with typically longer latency periods reported in existing literature.
Observation:
- An 18-year-old male presented with left shoulder pain and sensory disturbances.
- He had a history of meningitis and brain abscess treated 1.5 years prior.
- Magnetic resonance imaging (MRI) revealed a syrinx extending from the upper cervical to the lower thoracic spinal cord.
Findings:
- The patient's MRI during the brain abscess phase showed a posterior cerebellar arachnoid cyst.
- Syringomyelia developed within 9 months of the initial brain abscess onset, a notably rapid progression.
- Surgical intervention, including posterior fossa decompression and reopening of the Magendie's foramen, led to symptom and MRI improvement within one month.
Implications:
- This case suggests that basal arachnoiditis and posterior cerebellar arachnoid cysts may accelerate syringomyelia formation after cerebritis.
- The rapid onset observed necessitates prompt neuroimaging and consideration of surgical intervention in similar cases.
- Understanding the relationship between arachnoid cysts and syringomyelia progression can inform clinical management and prognosis.