1124 - Ascending Syringomyelia with Syringobulbia in a 22-year-old Male with a Motor-Complete Spinal Cord Injury

Case Diagnosis: Ascending syringomyelia with syringobulbia in a 22-year-old male with a motor complete spinal cord injury

Case Description: A 22-year-old male with motor complete paraplegia after a fall presented with three weeks of worsening dysesthesia in his left arm and hand. Initial symptoms included pain, tingling, and numbness in the medial forearm radiating to all digits. Pregabalin was discontinued due to ineffectiveness and adverse effects. While awaiting an electrodiagnostic study, his condition rapidly declined, with left facial numbness, dysphagia, nausea, and vomiting. MRI demonstrated a syrinx extending from T2 to the pons. He underwent emergent syringostomy, resulting in rapid improvement in swallowing and dysesthesia. During a short inpatient rehabilitation course, he regained functional independence, though persistent neuropathic pain remained in the left upper extremity.

Discussions: Post-traumatic syringomyelia (PTS) is a delayed complication of spinal cord injury, reported in up to 30% of long-term follow-up imaging. Syringobulbia, representing syrinx extension into the brainstem, is rare and may present with cranial nerve or respiratory compromise. Both conditions result from disrupted cerebrospinal fluid flow. Symptoms vary with lesion location and include neuropathic pain, motor weakness, bulbar dysfunction, and sensory decline. MRI remains the diagnostic gold standard. Management often involves decompression or shunting, though outcomes depend on timely recognition. This case underscores the critical role of multidisciplinary surveillance and early imaging in SCI patients with new neurological deficits.

Conclusions: This case illustrates the importance of ongoing follow-up for patients with SCI by specialized rehabilitation teams. Early recognition of neurological change is vital, as delays in imaging can lead to permanent disability. Physiatrists are uniquely positioned to detect subtle functional decline, initiate urgent evaluation, and coordinate surgical and rehabilitative management. Prompt intervention may prevent devastating outcomes in rare but serious conditions such as syringobulbia.