A patient with high cervical tetraplegia with new-onset headaches and posttraumatic syringomyelia is presented. Percutaneous drainage of the syrinx resulted in a resolution of the headaches and collapse of the syrinx on follow-up magnetic resonance imaging (MRI). The return of the symptoms correlated with the re-expansion of the syrinx on MRI. The patient underwent syringopleural shunting with persistent resolution of the symptoms and collapse of the syrinx on MRI. The value of percutaneous drainage and serial MRI to determine the clinical significance of posttraumatic syringomyelia is discussed.