Cases reported "Syringomyelia"

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1/10. syringomyelia associated with hydrocephalus and Blake's pouch cyst: case report.

    STUDY DESIGN: This is a case report of a 37-year-old woman who sought treatment for a large syringomyelic cavitation extending from C3 to the entire medulla, a tetraventricular hydrocephalus, and a cystic cavitation in the posterior cranial fossa communicating with the fourth ventricle (Blake's pouch cyst). The patient underwent a decompressive craniectomy, a C1 laminectomy, and the opening of the cysts to enable communication with the subarachnoid spaces. After an initial period of symptom remission, reassured by the magnetic resonance images indicating a reduction of the syringomyelia, the patient's neurologic conditions deteriorated because of further dilation of the ventricular cavities, which was resolved by the insertion of a ventriculoperitoneal shunt. OBJECTIVE: To suggest the treatment of choice in a patient with syringomyelia and hydrocephalus caused by Blake's pouch cyst. SUMMARY OF BACKGROUND DATA: Blake's pouch cyst is an entity often poorly understood, deriving from nonperforation of the primitive foramen of Magendie, causing a precarious equilibrium of the cerebrospinal fluid flow resulting from a defect in communication between the fourth ventricle and the encephalic and spinal subarachnoid spaces. Authors report the association of Blake's pouch cyst with cervicodorsal syringomyelia and tetraventricular hydrocephalus. methods: A case of syringomyelia associated with hydrocephalus and Blake's pouch cyst is described. RESULTS: Symptoms of syringomyelia and hydrocephalus disappeared only after positioning of a ventriculoperitoneal shunt. CONCLUSIONS: The treatment of choice for a case of syringomyelia associated with Blake's pouch cyst and hydrocephalus is the application of a ventriculoperitoneal shunt or, even better, an endoscopic third ventriculostomy.
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2/10. Radiologic demonstration of syringobulbia. Report of 8 cases.

    Out of 75 syringomyelia cases, 8 had a syringobulbic extension. The cavity was demonstrated by magnetic resonance imaging (3 cases), syringography (3 cases), ventriculography (2 cases), and myelo-CT (2 cases). The cavities could be separated into 2 groups. In the first (5 cases) the cavity extended from the floor of the fourth ventricle, anterolaterally (3 cases) or anteriorly in the midline (2 cases). The communication with the fourth ventricle was usually wide. In the second group (3 cases), the syringobulbic cavity was located anteriorly; 2 of the 3 had no communication with the fourth ventricle and had an exceptional cranial extension (syringocephalia). In selected cases, invasive studies may help to recognize the connections of the cavities, and thus be useful in planning the surgical treatment.
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3/10. Posttraumatic syringomyelia with paroxysmal episodes of unconsciousness.

    A 41-year-old man survived 23 years with quadriplegia following a C-5 fracture dislocation. During the last four months of his life he had paroxysmal episodes of unconsciousness. Necropsy disclosed a posttraumatic syrinx. The cyst extended caudally to the midlumbar region and rostrally into the midline of the medulla without communication into the fourth ventricle. Central apnea due to expansion of the cyst in the medullary respiratory centers is postulated as the possible cause of his paroxysmal episodes of unresponsiveness.
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4/10. A critical appraisal of "terminal ventriculostomy" for the treatment of syringomyelia.

    The clinical course of 31 patients who underwent attempted excision of the filum terminale and tip of the conus for syringomyelia is summarized. Of these patients, 17 had had some previous surgical intervention. Eleven patients were continuing to deteriorate at the time of the operation. In three cases, marked postoperative improvement was reported, and objective improvement was thought to result from the conus excision. Eighteen more patients claimed improvement in their preoperative symptoms of loss of pain sensibility, deafness, or reduced motor function, although most of such claims were unverified by objective clinical assessment. Sixteen of the patients who improved have since proceeded to deteriorate. In five of the patients, there was a long-standing improvement of at least subjective phenomena. Thirteen patients were not improved even subjectively and some of these have continued to grow worse. Proof that the greater part of the syrinx was in communication with the conus or filum was difficult to obtain even when the conus was dilated. No correlations have been found to suggest that the operation might be more effective if the central canal was patent at the conus or the filum, nor was there a correlation between a good clinical result and either the age of the patient or the age of the syrinx as judged by the history. The operation did not seem to be more or less beneficial if previous surgery had been performed. The suggestion is made that for syringomyelia with hindbrain abnormalities, other than dense arachnoiditis (particularly if there is evidence of pressure dissociation at the foramen magnum), craniovertebral decompression remains the procedure of choice. In syringomyelia with marked hydrocephalus, drainage by a valved shunt may be the preferred first procedure. If myelotomy is planned it should probably be done where the syrinx is wide, and it is more likely to succeed if the syrinx is drained to a low-pressure area outside the theca, such as the peritoneum or pleura, rather than the subarachnoid space.
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5/10. Posttraumatic syringomyelia. Case report.

    The ninth case of posttraumatic syringomyelia with postmortem confirmation is presented. Onset of symptoms occurred 19 years after the original trauma. The review of the literature with a discussion of postulated mechanisms of syrinx distention follows. The present case differs from previously reported postmortem cases in that there was communication through the medullary parenchyma with the fourth ventricle.
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6/10. Spontaneous drainage of syringomyelia. Report of two cases.

    Two cases are reported of Arnold-Chiari type I malformation associated with syringomyelia, in which magnetic resonance (MR) imaging revealed spontaneous decompression of the syrinx. In one case axial MR imaging sections showed a communication between the syrinx and the spinal subarachnoid space, which supports the hypothesis that fissuring of the cord parenchyma is instrumental in the spontaneous resolution of syringomyelia. The MR imaging changes were not accompanied by variations in the patients' clinical course.
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7/10. Syrinx-fourth ventricle and lateral ventricle-peritoneal shunts for congenital hydrocephalus with syringobulbia and syringomyelia: case report.

    A case of congenital hydrocephalus with syringobulbia and syringomyelia was reported. Although his neurological condition had deteriorated because of shunt malfunction, progressing syringobulbia, and syringomyelia, he recovered because of the direct communication from the syrinx in the medulla to the fourth ventricle, the shunt from the syrinx in the cervical spinal cord to the fourth ventricle, and the lateral ventriculoperitoneal shunt.
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8/10. Three cases of communication syringomyelia secondary to midbrain gliomas.

    Three cases of midbrain gliomas are descrbied clinically and pathologically. In each case high pressure symptoms were followed by visual disturbance and the onset of syringomyelia symptoms before death. All the patients had hydrocephalus. In one case with concomitant syringobulbia, the syrinx appeared to due to CSF communicating with the cord cavity through the tissues of the brain stem. In the other cases the communication between the CSF pathways and the syrinx was at the usual site, through the central canal at the obex.
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9/10. electrodiagnosis in post-traumatic syringomyelia.

    Development of a syrinx several years post spinal cord trauma is a well-known entity and described in a number of scientific communications. Each one describes the few cases encountered with the clinical presentations; many report results of myelography with positive or negative contrast media, operative procedures, and eventual outcome as well as discussions of autopsy material. It is believed by many investigators and clinicians that surgical intervention frequently stops the progression of the syrinx and sometimes even reverses the symptomatology. Early exact diagnosis is thus paramount. electromyography if used judiciously, may be an important adjunct to proper diagnosis and prognosis. In a patient with previous spinal cord trauma, frequently even post-surgical procedures, the interpretation is often difficult. This paper discusses the electrodiagnostic findings in three patients with post-traumatic syrinx and compares them with electrodiagnostic changes observed in a spinal cord injury patient with increased symptomatology due to other causes and two patients with non-traumatic cervical syringomyelia.
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10/10. syringomyelia associated with postmeningitic spinal arachnoiditis. Filling of the syrinx through a communication with the subarachnoid space.

    A patient is described who became paraplegic because of postmeningitic spinal arachnoiditis. Twelve years later, upper limb signs appeared. syringomyelia of an unusal communicating type was demonstrated by air myelography: air, introduced by lumbar route, filled syrinx up to the level of the first cervical vertebra, through a communication with the subarachnoid space at the thoracic level.
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