Neurology Resident and Fellow Section

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Presentation transcript:

Neurology Resident and Fellow Section A 39-year-old man with 1-year history of shoulder pain, swelling and limitation of movement Teaching NeuroImages Neurology Resident and Fellow Section © 2017 American Academy of Neurology

Vignette A 39-year-old man presented with 1-year history of shoulder pain, swelling and limitation of movement. There was a 20-year history of left shoulder and arm numbness. Examination showed decreased vibratory sensitivity on left shoulder, glenohumeral instability and dislocation. A radiography is attached (Figure 1). A spine MRI was performed due to numbness in the left arm (Figure 2). © 2017 American Academy of Neurology Bocca LF et al.

Imaging Shoulder radiography shows humeral head destruction (arrow). Bocca LF et al. © 2017 American Academy of Neurology

Imaging (A) Sagittal T2-weighted spine MRI shows tonsillar herniation (curved arrow) and cervical syringomyelia (straight arrows). (B) Axial T2-weighted spine MRI discloses lateral syringomyelia (left side), the same side of the Charcot shoulder. (C) Sagittal T1-weighted spine MRI shows the Chiari malformation with tonsillar herniation (curved arrow) and syringomyelia. © 2017 American Academy of Neurology Bocca LF et al.

Final diagnosis: Charcot shoulder: Chiari malformation with syringomyelia associated with arthropathy Chiari type 1 malformation may be associated to syringomielia, and may cause sensory loss.1 Charcot arthropathy is characterized by destruction of the related joint in patients with neurosensory loss.1,2 The shoulder may be affected by syringomyelia-induced neuropathy, causing Charcot shoulder.2 References: Yanik B, Tuncer S, Seckin B. Neuropathic arthropathy caused by Arnold-Chiari malformation with syringomyelia. Rheumatol Int 24:238-241. Liu H, Wang Y, Yang Z, Wang K. A case report of Charcot arthropathy caused by syringomyelia and Chiari malformation complicated with scoliosis. BMC Res Notes 2014;7:277. © 2017 American Academy of Neurology Bocca LF et al.