Spontaneous regression of post-traumatic syringomyelia: longitudinal mr imaging demonstrating a dynamic disease course.

INTRODUCTION

Posttraumatic syringomyelia is a recognized complication of spinal cord injury, often associated with progressive neurologic decline and surgical management. Its natural history remains incompletely understood, and spontaneous resolution is rare.

CASE PRESENTATION: We performed a literature review identifying six previously reported cases of spontaneous radiologic resolution of posttraumatic syringomyelia and report a 69-year-old patient with posttraumatic cervicothoracic syringomyelia showing a dynamic course characterized by initial mild enlargement followed by spontaneous radiologic resolution over 13 years of follow-up. Initial MR imaging in 2013 demonstrated a focal expansile syrinx at C7-T1 without enhancement, cerebrospinal fluid flow obstruction, or Chiari malformation. At presentation, the patient reported occipital headaches, dizziness, and subjective upper extremity weakness. Serial MR imaging demonstrated mild interval enlargement in 2019, followed by progressive decrease in 2022 and 2024, and near-complete resolution in 2026, with a residual slit-like cavity and focal cord thinning. Neurologic examinations remained normal throughout follow-up, and symptoms resolved.

DISCUSSION: This case demonstrates a dynamic course of posttraumatic syringomyelia with spontaneous radiologic resolution and clinical stability in the absence of surgical intervention. These findings suggest that a subset of patients may follow a benign or reversible course, supporting close clinical and imaging follow-up in selected cases.