1218 - Delayed Care in the Setting of Socioeconomic Barriers and Health Inequity in a Patient with Giant Syrinx

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

BM

Bradley Martin, n/a

Medical Student
Lewis Katz School of Medicine at Temple University
Wynnewood, Pennsylvania, United States

Co-Author(s)

WB

William L. Bockenek, MD, CPE

Clinical Professor/Chief Medical Officer
Carolinas Rehabilitation/Atrium Health/WFSM
Charlotte, North Carolina, United States
CC

Christopher Cappello, MD

Resident Physician
Carolinas Rehabilitation
Charlotte, Maryland, United States

Case Diagnosis: Post-Traumatic Syringomyelia

Case Description: A 41-year-old non-English speaking Latinx male with a remote history of a work-related T12 vertebral fracture and incomplete L1 paraplegia presented with new complaints of severe and disabling hyperesthesia and decreased sensation in the thoracic region and left upper limb. An MRI was ordered, but the patient was lost to follow-up. The delay in care resulted in part due to poor communication by his case manager, constrained resources during the pandemic, and potential cultural barriers related to language and medical mistrust. Over a year later, an MRI was re-ordered and a giant syrinx extending from the brainstem to the conus medullaris was identified. Five months later, neurosurgery placed a syringo-subarachnoid shunt, and post-surgical MRI showed significant decompression of the syrinx. At follow-up, the patient demonstrated notable improvement in left upper limb function, pain, and sensory deficits.

Discussions: This case highlights the identification and treatment of an extensive post-traumatic syringomyelia, as well as the system-based practice and health equity issues that are often seen within diverse patient populations. It is suggested that syringomyelia results due to inflammation and scar tissue formation and is often associated with spinal cord tethering and new onset dissociated sensory loss. Post-traumatic syringomyelia is relatively common (25-30%) following spinal cord injury (SCI) with literature estimating symptomatic presentation in about 3-8%. This patient’s diminished ability to advocate for care and dependence on worker’s compensation made prompt care more challenging. Transfer of care during the pandemic and delayed completion of imaging only exacerbated the situation.

Conclusions: Though this patient did have significant improvement after surgery, this case emphasizes the need to anticipate barriers and potential health inequities that may complicate care, especially when serious complications like syringomyelia arise in patients with SCI.