Resolution of spinal syringes and Chiari I malformation in a child. Case illustration.

Abstract

The clinical presentation and natural history of syringomyelia are extremely variable and unpredictable. In recent years, magnetic resonance (MR) imaging has improved our ability to study the natural history and clinical course of syringomyelia, enabling us to develop better rational management schemes. The case of a child who had spontaneous resolution of incidentally found cervical and thoracic syringes, as well as improvement in an associated Chiari I malformation documented by MR imaging, is illustrated. Now aged 12 years, this boy was well until the age of 5 years when he developed a complex partial seizure disorder. His initial seizure evaluation included craniospinal MR imaging that revealed incidental syringes extending from C3–7 and T5–8 as well as a Chiari I malformation (Fig. 1). His initial neurological examination was unremarkable and without evidence of scoliosis. The boy was followed biannually with craniospinal MR studies and he remained asymptomatic. At 7 1/2 years of age, follow-up MR imaging demonstrated that the two syringes were diminished in size. At 10 1/2 years of age, follow-up MR imaging demonstrated spontaneous resolution of cervical and thoracic syringes as well as improvement in the Chiari I malformation (Fig. 2). The child has remained asymptomatic over a 6-year period with a normal neurological examination and no evidence of scoliosis. This case illustration contributes to the literature on the natural history of syringes and suggests that a newly diagnosed patient with syringomyelia and Chiari I malformation without associated clinical symptoms, such as the child presented in this case illustration, may be followed with serial diagnostic MR studies and neurological examinations in lieu of immediate surgical management.