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Occult tethered cord syndrome: a reversible cause of paraparesis not to be missed

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Abstract

A 15-year-old female former gymnast with a history of pectus excavatum was reviewed due to unexplained paraparesis and urinary incontinence since age 10. Symptoms were commenced with intolerable upper back pain and development of a soft mass at the sacrum that remitted spontaneously. Brain and whole spine MRI imaging and blood and CSF testing were normal. The combination of skeletal, neurological, and bladder symptoms with normal lumbar MRI and abnormal urodynamic and neurophysiological studies led to the clinical suspicion of occult tethered cord syndrome (oTCS). Surgical cord “untethering” was performed leading to remarkable postoperative clinical improvement. oTCS is a recently defined functional disorder of the spinal cord due to fixation (tethering) of the conus medullaris by inelastic elements that may lead to severe neurological impairment. High clinical suspicion is required as oTCS is a treatable spinal cord disorder.

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Acknowledgments

The author would like to thank the patient and the family.

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Authors and Affiliations

  1. Neurophysiology Department, Sunderland Royal Hospital, South Tyneside & Sunderland NHS Foundation Trust, Sunderland, United Kingdom

    Dimitrios Tsiptsios

  2. Neurology Department, “Evexia” Rehabilitation Center, Chalkidiki, Greece

    Dimitrios Tsiptsios & Emmanouil Kandilakis

  3. Department of Pediatric Neurosurgery, Almazov National Medical Research Centre, St. Petersburg, Russian Federation

    Kirill Sysoev

  4. First Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Anastasios Anastasiadis

  5. Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom

    Konstantinos Tsamakis

  6. Second Department of Psychiatry, School of Medicine, University General Hospital “Attikon”, Athens, Greece

    Konstantinos Tsamakis & Emmanouil Rizos

Authors
  1. Dimitrios Tsiptsios
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  2. Kirill Sysoev
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  3. Anastasios Anastasiadis
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  4. Konstantinos Tsamakis
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  5. Emmanouil Rizos
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  6. Emmanouil Kandilakis
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Correspondence to Dimitrios Tsiptsios.

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Tsiptsios, D., Sysoev, K., Anastasiadis, A. et al. Occult tethered cord syndrome: a reversible cause of paraparesis not to be missed. Childs Nerv Syst 36, 2089–2092 (2020). https://doi.org/10.1007/s00381-020-04701-8

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  • DOI: https://doi.org/10.1007/s00381-020-04701-8

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