Syringomyelia in a patient with a history of hemiplegia in childhood

Introduction: Syringomyelia is a spinal cord cavitation disorder with an incidence of 8.4 per 100,000 inhabitants, predominantly manifesting in young adults (around age 30). Its pathophysiology involves alterations in cerebrospinal fluid dynamics and is associated with Chiari I malformation in 90% of cases. The clinical presentation, determined by the location of the cyst, includes loss of thermal and pain sensitivity, pyramidal signs, and muscle atrophy. Case report: A 67-year-old male with a history of hypertension and epilepsy presented with a 5-month history of walking inability. Neurological examination revealed interosseous atrophy, spastic quadriparesis, sensory level at T4, and pyramidal signs. Magnetic resonance imaging confirmed the diagnosis of syringomyelia. Surgical intervention was performed via a posterior craniocervical approach, involving durotomy (with observed CSF outflow under pressure), excision of the syrinx cavity capsule, and duraplasty. Postoperative evolution and rehabilitation were satisfactory. Conclusions: This case underscores the efficacy of management based on accurate imaging diagnosis and timely surgical intervention. Presentation in the seventh decade represents a significant variation from the usual epidemiological pattern, possibly influenced by a history of hemiplegia in childhood. Surgical decompression proved to be a fundamental therapeutic strategy, capable of favorably modifying functional prognosis, even in elderly patients.