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Rehabilitation Practice and Science

Translated Title

蜘蛛網膜下腔出血後續發脊髓空洞症：病例報告

Abstract

Background: Cerebral artery aneurysm rupture is one of the common causes of subarachnoid hemorrhage. Patients with subarachnoid hemorrhage may have some degree of neurological defects and impairment on activity of daily living. Syringomyelia refer to the cavity formation in spinal cord. Possible etiologies may include congenital and acquired types. Patients with syringomyelia may suffer from limb pain and paresthesia. According to previous studies, secondary syringomyelia due to subarachnoid hemorrhage was not common. Hence, a case with syringomyelia secondary to subarachnoid hemorrhage was presented by introducing the clinical signs and image findings. Moreover, current literatures about syringomyelia secondary to subarachnoid hemorrhage were reviewarticleed, and the diagnosis, treatments, and prognosis were discussed. Case: This is the case of a 35-year-old male, who suffered from subarachnoid hemorrhage due to right vertebral artery aneurysm rupture, complicated with hydrocephalus status post ventricle-peritoneal shunt placement six months ago before the first admission to rehabilitation ward for the recovery of left limbs weakness. During the first admission, he complained of left shoulder pain and numbness. The pain and numbness were distributed over the left upper arm. No obvious reliving or worsening factors about the symptoms were observed. Physical examination showed decreased in pinprick sensation over the left second cervical to the first thoracic dermatome. The left upper limb showed decreased deep tendon reflex. The source of the weakness and paresthesia of the left upper limb was suspected to be due to the diseases of the muscle, nerves and bones of the neck and shoulder. Hence, several examinations were performed. Cervical X-ray showed mild degenerative changes in the cervical spine with no evidence of cervical vertebral compression fracture or spondylolisthesis. Soft tissue ultrasound of the left shoulder showed left supraspinatus impingement with partial tear and tendinosis. The nerve conduction study of the bilateral upper limbs showed the possible left cervical radiculopathy. The initial impression was left cervical radiculopathy and left supraspinatus impingement with partial tear and tendinosis. A rehabilitation program was prescribed for him. However, the symptoms persisted and relapsed. Brain computed tomography was checked. Evidence of new intracranial hemorrhage or hydrocephalus were not observed. Cervical magnetic resonance imaging (MRI) was performed under the suspicion of spinal cord lesions, which showed syringomyelia form C1 to C7 levels. Further rehabilitation training and clinical follow-up were conducted. Clinical signs were stable and deterioration of symptoms was not observed after four months of rehabilitation. Conclusion: Syringomyelia is more common in traumatic spinal cord injury. Only few reports about the secondary syringomyelia due to subarachnoid hemorrhage have been reported. The pathophysiology may be due to the disturbance of normal cerebral fluid circulation after the subarachnoid hemorrhage. This case presented the possibility of secondary syringomyelia after subarachnoid hemorrhage. Hence, if a patient with subarachnoid hemorrhage has persistent limbs pain and paresthesia, with multiple dermatome involvement which can not be explained by mononeuropathy, the spinal MRI examination for the survey of syringomyelia should be considered.

Language

Traditional Chinese

First Page

141

Last Page

148

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