JNNP: Spontaneous resolution of cervical thoracic syringomyelia after significant weight loss

Syringomyelia or cavitation is a fluid-filled cavity in the spinal cord that can produce symptoms of progressive myelopathy
.

The standard of care for large symptomatic lesions includes direct surgical intervention

A 42-year-old morbidly obese woman with a body mass index (BMI) of 52kg/m ² and clinical symptoms manifested as persistent radiating pain in her hands for several months
.

The patient described intermittent paresthesias and loss of temperature sensation in his left hand larger than his right hand

² Magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) flow imaging sequences of the brain, cervical spine, thoracic spine and lumbar spine showed no occult tumors, arachnoid webs and intracranial lesions

MRI results of the first consultation before weight loss in 2017 (A) MRI T2 without cervical spine contrast, sagittal reconstruction: shows the huge T2 high signal of the entire cervical spinal cord, which is most consistent with syringomyelia
.

It is worth noting that there is no ectopic tonsil suggesting Chiari malformation

Taking into account the patient's morbid obesity and relatively mild neurological symptoms, the patient agreed to undergo a weight loss test to reduce the risk of surgery
.

Referral to nutritionists and weight-loss specialist surgeons, and plans to have imaging follow-up within one year

²

MRI results after significant weight loss in 2020 (A) MRI T2 has no cervical spine contrast, sagittal reconstruction: the large cervical spine almost completely disappears, T2 low signal is normal, representing the cervical spinal cord
.

There is a new, accidentally discovered tonsil ectopic, and the compression of the medulla has been resolved (B) MRI T2 without thoracic spine contrast, sagittal reconstruction: normal thoracic spine without cavity (C) MRI T2 without cervical spine contrast, axial reconstruction : Cervical spinal cord has only a small part of T2 hyperintensity, which is almost completely dissolved cavity at C1-C2 level (D) MRI T2 without thoracic spine contrast, axial reconstruction: normal thoracic spinal cord T1-T2 level without cavity

Syringomyelia is most often associated with Chiari malformation and can be secondary to trauma, intramedullary tumors, or tethered cord
.

After decompression of the posterior fossa, syringomyelia was indeed resolved in these cases, as expected by the Chiari I malformation

Another report described a woman with IIH who had cervical thoracic cavitation caused by iatrogenic overwork.
Translumbar-abdominal shunt disappeared after pregnancy due to the physiological changes in the shunt caused by the increase in intra-abdominal pressure during delivery
.

In fact, the disturbance of cerebrospinal fluid flow dynamics can be resolved with weight changes, as reported by bariatric surgeons in the IIH resolution experience of rapid weight loss

Therefore, with weight loss, cerebrospinal fluid reabsorption may increase
.
The spontaneous resolution of syringomyelia is possible, which may be a coincidence with the weight loss of the patient
.
Nevertheless, for non-mechanical syringomyelia, weight loss may be a conservative treatment option
.
Braythe DP ,BouobdaG ,Laxpatithe NG Bray  the DP Bray Bouobda  G Bouobda Laxpati  the NG Laxpati , et Al Spontaneous Resolution of cervicothoracic spinal Cord After Syrinx Significant weight Loss Journal of.
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