A case of multiple sclerosis with syrinx formation demonstrated on MRI

A 26-year-old woman developed two separate episodes of myelopathy mainly presenting paraparesis. Neurologic examination disclosed flaccid paraparesis associated with slight spasticity of the right arm. Deep tendon reflexes were generally hyperactive with positive bilateral Babinski and Chaddock reflexes. Arm pronation sign and Barre leg signs were bilaterally positive. Sensory disturbance below T6, and diminished vibration and position sense in both legs were seen. Urinary and fecal disturbances were also present. She could walk, but her gait was unsteady. Brain MRI showed abnormal high signal intensity areas on T2-weighted image at the left fronto-parietal lobe and right temporo-parietal lobe. Spinal MRI disclosed a cavity formation which was delineated low signal intensity on T1-weighted image through T4 to T8 and high signal intensity on T2-weighted image through T3 to T10. From these clinical manifestations and radiological findings, she was able to be diagnosed to have definite MS. The coexistence of syrinx formation in MS has rarely been reported, and only 5 cases including our case were found. These cases are characterized by the central localization of syrinx, and fair prognosis in their neurological features.