Korean J Neurotrauma.  2019 Oct;15(2):187-191. 10.13004/kjnt.2019.15.e22.

Presyrinx Associated with Post-Traumatic Hydrocephalus Successfully Treated by Ventriculoperitoneal Shunt

• Ha JH
• Hwang SC

• KMID: 2461126
• DOI: http://doi.org/10.13004/kjnt.2019.15.e22

Abstract

Presyrinx consists of reversible spinal cord swelling without frank cavitation, as observed on T2 weighted magnetic resonance imaging (MRI). The condition may evolve into syringomyelia, but timely surgical interventions have achieved meaningful results. Here, we report the case of a 27-year-old woman who presented with headache, dizziness, and diplopia 2 months after suffering a mild head trauma. On MRI, hydrocephalus, downward herniation of the cerebellar tonsil, and a diffuse high signal change in the cervical spinal cord were detected. After insertion of a ventriculoperitoneal shunt, her neurological symptoms resolved, and she has had no signs of presyrinx recurrence for >4 years.

Keyword

Presyrinx; Syringomyelia; Hydrocephalus; Arnold-Chiari malformation

MeSH Terms

Adult
Arnold-Chiari Malformation
Cervical Cord
Craniocerebral Trauma
Diplopia
Dizziness
Female
Headache
Humans
Hydrocephalus*
Magnetic Resonance Imaging
Palatine Tonsil
Recurrence
Spinal Cord
Syringomyelia
Ventriculoperitoneal Shunt*

Figure

• 

  FIGURE 1 MR images of 27-year-old woman who complained of headache and posterior neck pain after suffering a minor head trauma 2 months earlier. (A) Axial T2-weighted MR image of the gadolinium-enhanced brain shows the dilated lateral ventricles with Evan's ratio of 0.332, with no space-occupying or enhanced lesions in the brain. (B) Sagittal T1-weighted MR image shows dilation of the 4th ventricle and 13 mm downward herniation of the cerebellar tonsil, indicative of a Chiari malformation. (C) Cervicothoracic spinal T2-weighted MR image shows downward herniation of the cerebellar tonsil by 13 mm. An area of T2 prolongation in the dilated cervical spinal cord without frank cavitation is consistent with the radiographic definition of presyrinx, in this case, from C1 to T5.MR: magnetic resonance.

• 

  FIGURE 2 Follow-up images show radiographic improvement after surgical intervention to address the presyrinx with hydrocephalus and Chiari type 1 malformation. (A) Axial brain computed tomography image obtained 7 days after ventriculoperitoneal shunting shows the inserted shunt catheter and the improved status of the hydrocephalus. (B, C) Cervical T2-weighted magnetic resonance images show reduction in the cervical spinal cord swelling at 8 days (B) and 10 months (C) postoperatively. Preoperatively noticed 13 mm downward herniation of cerebellar tonsil was decreased to 11 mm (B) and 9 mm (C), respectively.

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