A clinical case of diagnostic and treatment error in syringomyelia

Introduction. Syringomyelia is a chronic progressive disease of the nervous system characterized by the formation of cavities within the spinal cord. Idiopathic syringomyelia, which is associated with the development of spinal cord cavities without an apparent cause, is of particular interest. This article describes a clinical case of syringomyelia where determining the etiology proved to be significantly challenging, to the extent that it could have been classified as idiopathic.

Aim of the study. To present a diagnostically complex case of syringomyelia for discussion and to propose a diagnostic approach for situations where verifying the cause is difficult.

Case description. The paper presents a clinical case of a patient who was admitted to the Irkutsk City Clinical Hospital No. 3 in January 2023. The patient’s complaints included severe progressive weakness in the legs (more pronounced on the left), moderate weakness in the arms, decreased sensation in the lower half of the body (more pronounced on the right), impaired temperature sensitivity on the back and abdomen, increased urinary frequency, and weakness in the left arm since December 2022. Over several years of seeking medical help, magnetic resonance imaging (MRI) and contrast-enhanced MRI had been performed repeatedly but failed to identify the cause of the disease. A comprehensive examination was conducted, including contrast-enhanced multispiral computed tomography with myelography, which revealed a blockage of contrast agent propagation in the posterior spinal subarachnoid space. Surgical treatment was performed, involving laminectomy of Th_III–Th_VI and microsurgical removal of a space-occupying lesion in the spinal canal at the Th_III–Th_V level using intraoperative ultrasound navigation. The postoperative course was uneventful, with regression of neurological symptoms noted. The follow-up period was over 3 months with a favorable outcome. Histological examination determined that the cause of syringomyelia in patient A. was a Grade 1 meningothelial meningioma, which did not accumulate contrast agent.

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