Holocord syrinx presenting as hemi anhidrosis
A 41-year-old man presented in medicine ward with a complaint of neck and back pain and loss of sweating in right side of the body that had begun eight months before. There was no history of trauma that could account for the pain. There was no history of dizziness or difficulty in swallowing. There was no history of hypertension, diabetes, and immunocompromised status. On examination whole left side of body including face was dry, there was no evidence of sweating [Figures and ]. Anhidrosis was tested by spoon test. This test is described as drawing a metal spoon across the surface of the skin after adequate physical Exercise. We could not do iodine starch test due to inadequate facility. There was slight ptosis on left side with normal pupil size bilaterally. Neurological examination was unremarkable with no limb weakness, wasting or numbness and temperature impairment on the side of anhidrosis. There was no facial asymmetry. His routine laboratory tests were within normal parameters. His chest x-ray was normal. This was done to rule out any mass in the upper lobe of the lung which may present as Horner syndrome. MRI spine was performed which showed hyperintense signal (red arrow head) in T2-weighted sections extending whole spinal cord up to eighth thoracic cord level with herniation of cerebellar tonsil (blue arrow head) compatible with syringomyelia along with Chiari I malformation []. Surgical treatment was recommended but the patient refused.