Early onset posttraumatic cystic myelopathy complicating spinal cord injury

Three cases of posttraumatic cystic myelopathy occurring early in the postinjury period are reported. A patient with C5 tetraplegia developed bilateral upper extremity paresthesias and right upper extremity weakness 2 and a half months postinjury necessitating immediate syringo-subdural shunting. A patient with C6 tetraplegia complained of left upper extremity paresthesias 2 months postinjury. A syringoperitoneal shunt was placed 19 months postinjury due to new onset intermittent weakness of the right upper extremity. A patient with C4 tetraplegia developed right upper extremity paresthesias, sensory loss, and weakness 56 days postinjury; it was treated conservatively. Two years postinjury he required surgery because of progression of symptoms. A review of the literature reveals that posttraumatic cystic myelopathy has been found to be an incidental pathologic finding at autopsy within 2 months postinjury. However, sensory and motor loss have not been clinically described as an early complication of spinal cord injury. We conclude that posttraumatic cystic myelopathy should be considered in the differential diagnosis of motor or sensory loss occurring early in the postinjury period.