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Case Studies is a new feature designed to highlight interesting patient
cases reported in the research. Given the lack of knowledge about
CM/SM, much of the published research comes in the form of case studies -
doctors describing one or two patients they have seen and treated - as
opposed to rigorous scientific studies. While this type of publication
doesn't advance the scientific cause as much, it does give us a window
into some of the issues surrounding CM/SM, including lasting side effects
and related conditions. And hopefully, some of our readers will say,
"Hey, that's just like me!" and know they are not alone in what they are
going through.
CASE 1: Skydiving
Reported In:
New England Journal of Medicine (Letter to the Editor), July 17, 2003.
Doctors: Dr. Charles Wrobel & Dr. Kevin Taubman, Kern Medical
Center, Bakersfield, CA.
Patient 1:
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30 year old male
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Owns a skydiving
school
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Over 1500 jumps
without injury
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Developed pain in
the chest/mid-back area
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MRI revealed a
syrinx
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Continued to
jump, but less frequently
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2 years later,
symptoms worsened, syrinx had enlarged
Patient 2:
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27 year old male
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Over 1000 jumps
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After a hard
parachute opening, developed neck pain and stiffness
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One month later
developed tingling and numbness in right arm
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MRI revealed a
15mm long syrinx in the cervical area
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Patient stopped
skydiving, symptoms went away and the syrinx stabilized
Observations:
Ed Note:
This case provides further evidence that trauma is a triggering
event for syringomyelia. There have been anecdotal reports of people
becoming symptomatic after riding roller coasters which entail similar (or
even greater) forces. Clearly not everyone who rides a roller coaster
or jumps from a plane develops SM, so I believe there is still an unknown
component which makes some people more susceptible to developing a syrinx
than others.
CASE 2: Bad Elbow
Reported In: Orthopedics (Case Report), July 2003
Doctors: Dr. Satoshi Nozawa et al., Dept. of Orthopedics, Gifu
University, Japan
Patient 1:
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57 year old
female
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Painless
instability and swelling of left elbow
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Had endured left
shoulder numbness for 17 years
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X-ray of the
elbow revealed destructive arthropathy (Charcot joint)
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MRI revealed
Chiari I malformation and a syrinx from C2-C7
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Patient underwent
decompression surgery
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2 years later,
the syrinx was smaller, there was less numbness in the shoulder, and the
destruction of the elbow had stopped progressing
Observations:
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Charcot joints -
joints undergoing damage due to loss of nerve function - in general are more
common in the legs and feet
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Because
neuropathic joints have lost nerve function, they are usually painless, but
they become unstable allowing the bones to grind against each other and
destroy the joint over time
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Neuropathic
elbows - although uncommon - have been linked to SM
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Treating the
underlying cause - SM - can stop the progression of a neuropathic joint
Ed Note:
Many syrinxes are located in the cervical region which supplies
nerves to the shoulders and arms. Thus if a syrinx damages nerves in
this area, a patient may develop problems with their shoulders and elbows.
Anecdotally, many SM patients have shoulder problems even after
decompression surgery.
CASE 3: Labor Management
Reported In: Journal of Perinatology, Nov., 2002
Doctors: Jason Parker, O.D. et al., Maternal-Fetal Medicine,
Madigan Army Medical Center, Tacoma, Washington
Patient 1:
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26 year old
female, first pregnancy
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Diagnosed with
syringomyelia in childhood, treated with a shunt placement
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During labor,
developed headaches, weakness, and numbness
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Concern was labor
was causing elevated ICP leading to further spinal compression
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Baby was
delivered immediately by cesarean section
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Slowly loaded
epidural was used for anesthesia to minimize further complications
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Baby was healthy,
patient's symptoms resolved within 24 hrs
Patient 2:
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30 year old
female, first pregnancy
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Known to have
Chiari malformation, syringomyelia, and a seizure disorder
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Neurological
symptoms were stable
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Slowly loaded
epidural was administered early in labor
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Patient was told
not to push during second stage of labor
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Baby was
delivered vaginally using forceps
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Baby was healthy,
patient had no neurological complications
Observations:
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Pushing during
labor can increase intracranial pressure (ICP) causing further compression,
worsening neurological symptoms, and potentially more herniation of a Chiari
malformation
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Despite the
risks, labor was successfully managed by either cesarean section or
vaginal delivery with no maternal pushing
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An epidural where
the anesthesia is slowly introduced can lower the risks associated with
regional anesthesia and avoid the risks of a general anesthesia
Ed Note:
Although this case highlights some of the problems that moms-to-be
must deal with, it also shows cases with successful outcomes. Back to Table of Contents |
arthropathy - damage to a joint
cerebrospinal fluid
(CSF) - clear liquid in the brain and spinal cord, acts as a shock
absorber
cervical - having to do with the upper portion of the spine located
in the neck area
Charcot joint - progressive, often painless, destruction of a joint
due to loss of nerve function Chiari malformation -
condition where the cerebellar tonsils are displaced out of the skull
area into the spinal area, causing compression of brain tissue and
disruption of CSF flow
decompression surgery - common term for any of several variations of
a surgical procedure to alleviate a Chiari malformation
ICP - intracranial pressure, pressure of CSF inside the skull area
neuropathic -arising from nerve damage
orthopedic - type of medicine dealing with bones, muscles, and joints
perinatology - type of medicine dealing with the period around
childbirth, both before and just after
syringomyelia (SM) - neurological condition where a fluid filled cyst
forms in the spinal cord
syrinx - fluid filled cyst in the spinal cord
thoracic - having to do with the middle part of the spine in the
chest area
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