Subdural Hematoma

ID/CC

HPI PE

Labs Imaging

Gross Pathology

Micro Pathology

Treatment Discussion

A 30-year-old man is referred ro a neurologist because of progressive anesthesia and weakness of both arms, occipital headaches, and a stiff gait.

He has no history of significant trauma in the past.

No motor deficits; lack of pain and temperature sensation in both hands and arms (due to spinothalamic tract involvement) but preserved position and tactile sensation (dorsal columns uninvolved and proprioceptive sensation spared); unimpaired pain and temperature sensation below arms; thenar muscles of both hands atrophied; areflexia in both upper limbs; brisk deep tendon reflexes in both lower limbs.

Normal.

MR/CT-Spine: cystic dilatation within central cervical cord.

Spinal cord shows central cavitation in longitudinal and cleftlike fashion.

Hydromyelia is lined by ependymal tissue; syringomyelia is not.

Surgical shunting.

Syringomyelia may be primary (associated with Arnold-Chiari malformation) or acquired (post-traumatic, postinflammatory, tumor-associated).

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