Chiari I malformation, syringomyelia and liver disease: An unusual resolution with implications for clinical practice

Abstract

Syringomyelia occurs in 40-65% of patients with Chiari I and up to 75% of patients with a syrinx have an associated Chiari I malformation (4,6). In patients with syringomyelia spontaneous radiological resolution accompanied by resolution (partial or com- plete) of the symptoms is rare. We present the only reported case to our knowledge of spontaneous resolution of a syrinx in an adult immediately following treatment for Hepatitis C. We propose that the patient's liver disease caused chronic central nervous system (CNS) edema with expansion of the spinal cord and exacerba- tion of a Chiari I malformation. Improvement in her liver function following successful Hepatitis C treatment resulted in significant reduction of the spinal cord edema, a slight reduction of the ton- sillar herniation and collapse of the syrinx. This case demonstrates that treatment of liver disease in this sub-group of patients may obviate the need to progress to surgical intervention.