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Posttraumatic syringomyelia: profound neuronal loss, yet preserved function

B Goldstein1, M C Hammond, S A Stiens

  • 1Spinal Cord Injury Service, DVA Puget Sound Health Care System, Seattle, WA 98108, USA.

Archives of Physical Medicine and Rehabilitation
|January 24, 1998
PubMed
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Posttraumatic syrinxes, fluid-filled cavities after spinal cord injury (SCI), can cause significant damage. Even with extensive neuronal loss, some patients may show minimal functional deficits.

Area of Science:

  • Neuroscience
  • Neuropathology
  • Spinal Cord Injury Research

Background:

  • Posttraumatic syrinxes are common after spinal cord injury (SCI) and can cause significant spinal cord dilation.
  • Neurologic deficits associated with syrinxes are often attributed to physical compression, but the extent of neuronal damage is not fully understood.

Observation:

  • A case study of a 49-year-old male with T4 paraplegia and a large posttraumatic syrinx is presented.
  • The patient underwent syringoperitoneal shunting and died 3 weeks post-operation.
  • Neuropathologic examination revealed extensive syrinx cavities and significant neuronal loss, including interneurons and motoneurons, from cervical to thoracic levels.

Findings:

  • Despite extensive neuronal loss in the spinal cord, the patient exhibited preserved motor function in wrist and elbow extensors.

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  • Manual muscle testing and functional assessments, such as sliding board transfers, indicated minimal clinical deficits.
  • Histological analysis revealed substantial loss of gray matter neurons, particularly interneurons, in spinal segments corresponding to areas of preserved motor function.

    • Implications:

    • This case challenges the notion that syrinxes solely cause deficits through physical dissection of neural tissue.
    • The findings suggest that significant neuronal damage, especially to interneurons, can occur without corresponding severe clinical manifestations.
    • Further research is needed to elucidate the mechanisms underlying the dissociation between neuropathologic findings and clinical presentation in posttraumatic syrinxes.