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Neurological picture
Spontaneous resolution of cervicothoracic spinal cord syrinx after significant weight loss
  1. David Painton Bray1,
  2. Georges Bouobda2,
  3. Nealen G Laxpati1,
  4. Matthew F Gary1
  1. 1Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
  2. 2Morehouse School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr David Painton Bray, Department of Neurosurgery, Emory University, Atlanta, GA 30322, USA; dbray3{at}emory.edu

https://doi.org/10.1136/jnnp-2020-325720

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    Introduction

    Syringomyelia or syrinx is a fluid-filled cavitation within the spinal cord that can produce symptoms of progressive myelopathy.1 Standard of care for large, symptomatic lesions involves direct surgical intervention. Here, we present a case of a woman who achieved spontaneous resolution of her cervicothoracic syrinx after significant weight loss.

    Case presentation

    A morbidly obese 42-year-old woman with body mass index (BMI) of 52 kg/m2 presented with months of progressive radiating pain to the hands. The patient described intermittent paresthesia and loss of temperature sensation in the left-greater-than-right hands. She had slight incoordination and weakness of the left hand, but was otherwise motor intact. She denied issues with gait instability or bowel/bladder incontinence. She had no antecedent history of trauma nor vision loss/symptoms of idiopathic intracranial hypertension (IIH).

    MRI of the cervical, thoracic and lumbar spine without contrast revealed a large, cervical and thoracic syrinx, measuring 14 mm in the greatest diameter (figure 1). Notably, she had no Chiari malformation. MRI of the brain, cervical, thoracic and lumbar spine with contrast as well as cerebrospinal fluid (CSF) flow imaging sequencing demonstrated no occult neoplasms, arachnoid webs, nor intracranial lesions.

    Figure 1

    Initial consultation MRI, before weight loss, year 2017. (A) MRI T2 without contrast of the cervical spine, sagittal reformat: reveals capacious T2 hyperintense signal throughout the entirety of the cervical …

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    Footnotes

    • Correction notice This article has been corrected since it was published Online First. Figure 1 was incorrectly displaying as a duplication of figure 2; the correct image has now been instated.

    • Contributors Each named author has substantially contributed to conducting the underlying research and drafting this manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests To the best of our knowledge, the named authors have no conflict of interest, financial or otherwise.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.