Faculty of Medicine, Riga Stradinš University, 16 Dzirciema Street, Riga, LV-1007, Latvia.
Children Clinical University Hospital, Vienības Gatve 45, Riga, LV-1064, Latvia.
Spinal Cord Ser Cases. 2024 Jun 10;10(1):41. doi: 10.1038/s41394-024-00654-1.
Syringomyelia, or the formation of fluid-filled cysts within the spinal cord, associated with delayed spinal arachnoiditis is an uncommon complication of aneurysmal subarachnoid haemorrhage. To date, about 18 cases have been reported in medical literature, with just two reported in patients under the age of 35 years.
A 27-year-old female patient complained of sudden, severe headaches in the occipital region, nuchal rigidity, and drowsiness when she presented at our institution. A head computed tomography scan revealed intraventricular bleeding in the lateral and fourth ventricles with more extensive haemorrhaging in the frontal horns. A left posterior inferior cerebellar artery (PICA) aneurysm was confirmed via digital subtraction angiogram, and endovascular embolization was done. Two years later, the patient reported intense pain in the lower back along with symptoms suggestive of spinal cord compression. Spinal magnetic resonance imaging (MRI) showed spinal adhesions from C1 to L4, syringomyelia with some vasogenic oedema extending from T3 to T9 level, and a cyst in the lumbar region. Consequently, a right hemilaminectomy was performed along with microsurgical release of arachnoid adhesions and placement of a subdural drain. Radiological and symptomatic improvements were observed. Since then, the patient's clinical condition has remained stable during the past three years of follow-up visits.
Literature on optimal treatment modalities and patient prognosis is scarce and debated. The time for symptom improvement depends on the level and extent of spinal cord involvement. Rehabilitation may be required for most patients, as complete symptomatic recovery may not be attainable.
脊髓空洞症，即脊髓内充满液体的囊肿形成，与延迟性脊髓蛛网膜炎相关，是蛛网膜下腔出血后少见的并发症。迄今为止，医学文献中报道了约 18 例，其中仅 2 例发生在 35 岁以下患者。
一名 27 岁女性患者因突发严重的枕部头痛、颈项强直和嗜睡就诊于我院。头颅 CT 扫描显示侧脑室和第四脑室的脑室内出血，额角有更广泛的出血。数字减影血管造影术（DSA）证实左侧后下小脑前动脉（PICA）动脉瘤，行血管内栓塞术。两年后，患者出现下背部剧烈疼痛和脊髓压迫症状。脊髓磁共振成像（MRI）显示 C1 至 L4 的脊髓粘连，从 T3 到 T9 水平有延髓积水性水肿导致的脊髓空洞症，以及腰椎区域的囊肿。因此，进行了右侧半椎板切除术，同时进行蛛网膜粘连的显微松解术和硬脑膜下引流术。影像学和症状均有改善。此后，患者在过去三年的随访中临床状况一直稳定。
关于最佳治疗方式和患者预后的文献稀缺且存在争议。症状改善的时间取决于脊髓受累的水平和程度。大多数患者需要康复治疗，因为可能无法完全恢复症状。
