A 49-year-old woman first developed symptoms in 1993 when, following a bout of coughing, she developed burning right-sided chest pain radiating to the right arm and worsening with straining. When examined in 2001, she was numb in the right flank to pinprick with allodynia to cold, and the biceps jerks were reduced bilaterally. Lower limb reflexes were brisk with flexor plantar responses, and no weakness was detected. Magnetic resonance imaging at this time (Figure, A) revealed an extensive syrinx from C2 to L1 and a Chiari type I malformation. She declined surgical intervention.
O’Riordan S, Stevens J, Chataway J. Spontaneous Improvement of Syringomyelia With Deterioration of a Chiari Type I Malformation and New Symptoms. Arch Neurol. 2006;63(9):1328. doi:10.1001/archneur.63.9.1328