Inaugural hyperhidrosis revealing syringomyelia in a spinal cord injured men T10 AIS A

Abstract

MRI has highly changed the assessment of post-traumatic syringomyelia (PTS), roughly estimated at 30% nowadays. Times to onset (TTO) symptoms are random. This case report describes how hyperhidrosis appeared and revealed PTS diagnosis. Mr M., 43-year-old, is rehabilitation inpatient after T10 AIS A spinal cord injury (SCI). Three months after this event, Mr M complains of acute hyperhidrosis crisis always located below the injury, which can occur at any time of the day, particularly when he moves. This symptom comes together with muscular hypertonia as lower limbs triple flexion scheme. Clinical and paraclinical investigations excluded predisposing factors as infectious process, thrombo-embolic disease, osteosynthesis instability. MRI will finally conclude with syringomyelia cavity, although none of the usual syrinx risk factors (absence of surgical treatment for spinal canal injury, cyphosis over 30%) were identified. PTS Always starts from injury location and is initially extra ependymal at dorsal horn basis. It grows following a necrosis of myelomalacia or hematoma resorption and its expansion will be favored by cerebro-spinal fluid flow abnormality. Hyperhidrosis is rarely known as PTS opening symptoms. Most frequent symptoms are pain further increased by movements or closed glottis efforts, changes in the neurological examination, muscular hypertonia increase, autonomic dysreflexia appearance and bladder disorders. In this case, PTS onset was extremely short. It usually appears 15 years on average after SCI, 5 years earlier for patients above 30 years old. Risks factors, such thoracic localization and AIS A scale speeding SPT TTO while incomplete injuries slowing SPT TTO. Hyperhidrosis might be more frequent sign in lower SCI level, blood pressure dysreflexia occur only in higher SCI level (> T6).