Transient syringomyelia leading to acute neurological deterioration after repair of a lipomyelomeningocele: case report.

Abstract:

OBJECTIVE:Transient paraplegia in the immediate postoperative period after lipomyelomeningocele repair is uncommon and is not discussed in the literature. We present the unique case of a patient who developed transient paraplegia 48 hours after lipomyelomeningocele repair attributable to the acute development of a thoracic syrinx. CLINICAL PRESENTATION:At birth, the patient was noted to have a large skin-covered mass in the lumbosacral region. On neurological examination, both iliopsoas and quadriceps exhibited 3/5 motor function, and the plantar flexors and dorsiflexors exhibited 1/5 motor function. Urodynamic studies were normal. Magnetic resonance imaging demonstrated the presence of a lipomyelomeningocele associated with tethering of the spinal cord in the lumbosacral region. INTERVENTION:At 5 months of age, the patient underwent repair of the lipomyelomeningocele. After surgery, the patient developed progressive paraplegia along with bowel and bladder dysfunction. Given the concern about a postoperative hematoma resulting in cauda equina syndrome, the patient returned to the operating room for a wound exploration. No compressive lesion such as a hematoma was found at surgery. A postoperative magnetic resonance imaging scan obtained afterward, however, demonstrated the presence of a large thoracic syrinx. CONCLUSION:Syrinx formation can occur as early as 48 hours after lipomyelomeningocele repair, leading to progressive lower extremity weakness and bowel and bladder incontinence. In the immediate postoperative period, an acute syrinx can mimic cauda equina syndrome, and a magnetic resonance imaging scan is necessary to distinguish between these two entities. In this patient, the syrinx was transient and resolved without a shunting procedure.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Post NH,Wisoff JH,Thorne CH,Weiner HL

doi

10.1227/01.NEU.0000255523.50203.FC

subject

Has Abstract

pub_date

2007-08-01 00:00:00

pages

E426; discussion E426

issue

2

eissn

0148-396X

issn

1524-4040

pii

00006123-200708000-00028

journal_volume

61

pub_type

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