Symptomatic Syringomyelia Associated with Acute Bacterial Me
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A 3-years-old boy weighing 13kg previously healthy, presented to FMIC with 1 week history of inability to move legs, stand & walk associated with fever, headache, vomiting and irritability. Problem started acutely with limping in right leg which gradually increased and in 2 days the child was not able to walk without support and then could not stand without support and finally the child became unable to move legs with sensory loss in legs and loss of sphincters control. During the illness patient was febrile, had headache, vomiting and irritable.

Patient was admitted for 3 days in a local hospital, treated with high dose of ceftriaxone. CBC and CRP was tested which were normal. After 3 days patient was referred to FMIC. At arrival in physical examination the child was ill looking, conscious level was altered, GCS 12/15, had neck stiffness. Deep tendon reflexes were absent in lower limbs sensation was impaired from toes to the hip joints. The case reported as an acute flaccid paralysis for polio screening.

CBC, CRP, SGPT, CPK, RFT, serum electrolyte was normal. Serum glucose level was 78mg/dl. Chest X-ray was normal and Monteux test was negative. Spine MRI revealed syringomyelia in dorso-lumber spine from D8-L1. Supportive treatment and combined antibiotics (Ceftriaxone and Vancomycin) started. On 3rd day of treatment patient was afebrile, had no vomiting and irritability. He was able to set in bed and play with toes. On 9th day of treatment CSF analysis showed glucose 74mg/dl (serum glucose 95mg/dl), protein 75mg/dl, cells 04/dl. Same treatment for 14 days were continued and patient was referred to the neurosurgeon.

Unfortunately, the patient was referred abroad by neurosurgeon and the family could not afford to take the child out of country, therefore the syringomyelia left untreated. Fortunately, patient was never febrile, he had good weight gain and always was playful but he was not able to move, paresthesia in legs with sphincters dysfunction persisted.

Symptomatic syringomyelia may occur even in children less than 5-year-old. CSF analysis in selected cases of syringomyelia is suggested to rule out associated central nervous system infection.