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Neurology (Expert Forum)
Syrinx
Answered by
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury
Syrinx
by mede, Jun 19, 2007 12:00AM
On a MRI in April 2006, the syrinx extended from C4-C5 through C7-T1 with widest diameter of 4mm. There was a tonsillar ectopic 8 mm on left and 12 mm on right. The posteria fossa was normal size and not caudally dislocated. The vertricles and cisterns were maintained and preserved. No areas of diff restriction. After decompression surgery in June 2006, there is a minimal tonsillar ectopia of 4 mm on right on MRI April 2007. Cervical cord syrinx extends from C4-C5 through C7-T levels. The craniocuadal measurement is 42mm and the widest diameter is 3.5mm. There is a partially visually upper thoracic cord with a syrinx measuring 2mm in diameter seen at the level of T4-T5. Degenerative disc changes at C5-6 with moderate central canal stenosis. Neuroforamen are mildly narrowed bilaternaly. After the surgery the extreme pain in my left arm has disappeared. I am moderately experiencing pain in my neck, shoulders, and arms. I have muscle cramps and twitching through my body. When should the syrinx disappear? Does it even matter that the syrinx is still there?
Doctor's Answer
by Joyce K Lee, MD, Oct 16, 2007 10:16PM
, Oct 16, 2007 10:16PM
To: mede
Dear Mede:
Thank you for submitting your question.
I will answer your concerns to the best of my abilities, but please be informed that I am unable to offer a diagnosis based on your history and list of symptoms.
I am extremely limited in not having the opportunity to perform a full neurologic examination on you, nor am I able to review the pertinent imaging.
This is solely for educational purposes and should in no way be a substitute for a formal evaluation by a certified physician.
I am assuming that your underlying diagnosis is a Chiari I malformation which you had surgically corrected via a decompressive surgery because it was not made very clear in your posted question.
I am sure that you already know quite a bit about Chiari malformations, but please allow me to offer a brief educational introduction before formally answering your questions.
Chiari type 1 malformations (CM1) occur in the region where the brain and the spinal cord join. In this disorder, the portions of the brain called the cerebellum and/or brainstem lie lower than usual and may protrude into the spinal canal. This causes a pressure phenomenon, leading to the following symptoms: headaches, especially at the base of the skull, dizziness, double vision, weakness in the arms, and/or difficulty walking.
The association between Chiari malformations and syringomyelia is well documented.
Syringomyelia is a disorder in which cerebrospinal fluid enters the spinal cord, forming a cavity known as a syrinx. The danger with a syrinx is that is has potential to expand and elongate over time, leading to destruction of the center of the spinal cord.
A syrinx usually causes a combination of the following symptoms: muscle weakness and spasticity, motor impairment, and sensory loss.
The treatment for both the Chiari malformation and the syrinx is decompressive surgery. The type of surgery is tailored to the extent of the disease.
The fact that you are having muscle pain and what sounds like spasms based on your description may or may not be related to the syrinx.
My suspicion is that if the pain is isolated and not accompanied by the symptoms above (weakness or sensory loss) that it is unrelated to the syrinx.
Rather, it may be post-operative spasms, primarily due to mobilization of the nearby muscles during surgery. We often see this type of pain in patients who undergo decompressive surgery for Chiari malformations, as well as patients undergoing spine surgery (in nearby locations for other reasons.) You are 3+ months into your post-operative period, but this can be seen as a delayed effect as well.
At our institution, we typically prescribe muscle relaxants like Flexeril (generic name Cyclobenzaprine) or a benzodiazepine like Valium (generic name Diazepam) to relieve this type of pain. Please be aware that medications of this nature have side effects, namely sedation and impairment of cognition. However if taken properly and as prescribed, patients rarely find these side effects troublesome.
I actually recently answered a similar question on this very program for another person which lets you know that your symptoms are not rare after decompressive surgery for Chiari’s.
I can’t answer your question on the expected time duration for a syrinx to disappear.
Some never disappear and some dissolve immediately.
The more important part of all of this is that you remain diligent about following up with your neurologist or neurosurgeon and have it routinely monitored.
I hope this helps,
Best regards,
JKL, M.D.
Thank you for submitting your question.
I will answer your concerns to the best of my abilities, but please be informed that I am unable to offer a diagnosis based on your history and list of symptoms.
I am extremely limited in not having the opportunity to perform a full neurologic examination on you, nor am I able to review the pertinent imaging.
This is solely for educational purposes and should in no way be a substitute for a formal evaluation by a certified physician.
I am assuming that your underlying diagnosis is a Chiari I malformation which you had surgically corrected via a decompressive surgery because it was not made very clear in your posted question.
I am sure that you already know quite a bit about Chiari malformations, but please allow me to offer a brief educational introduction before formally answering your questions.
Chiari type 1 malformations (CM1) occur in the region where the brain and the spinal cord join. In this disorder, the portions of the brain called the cerebellum and/or brainstem lie lower than usual and may protrude into the spinal canal. This causes a pressure phenomenon, leading to the following symptoms: headaches, especially at the base of the skull, dizziness, double vision, weakness in the arms, and/or difficulty walking.
The association between Chiari malformations and syringomyelia is well documented.
Syringomyelia is a disorder in which cerebrospinal fluid enters the spinal cord, forming a cavity known as a syrinx. The danger with a syrinx is that is has potential to expand and elongate over time, leading to destruction of the center of the spinal cord.
A syrinx usually causes a combination of the following symptoms: muscle weakness and spasticity, motor impairment, and sensory loss.
The treatment for both the Chiari malformation and the syrinx is decompressive surgery. The type of surgery is tailored to the extent of the disease.
The fact that you are having muscle pain and what sounds like spasms based on your description may or may not be related to the syrinx.
My suspicion is that if the pain is isolated and not accompanied by the symptoms above (weakness or sensory loss) that it is unrelated to the syrinx.
Rather, it may be post-operative spasms, primarily due to mobilization of the nearby muscles during surgery. We often see this type of pain in patients who undergo decompressive surgery for Chiari malformations, as well as patients undergoing spine surgery (in nearby locations for other reasons.) You are 3+ months into your post-operative period, but this can be seen as a delayed effect as well.
At our institution, we typically prescribe muscle relaxants like Flexeril (generic name Cyclobenzaprine) or a benzodiazepine like Valium (generic name Diazepam) to relieve this type of pain. Please be aware that medications of this nature have side effects, namely sedation and impairment of cognition. However if taken properly and as prescribed, patients rarely find these side effects troublesome.
I actually recently answered a similar question on this very program for another person which lets you know that your symptoms are not rare after decompressive surgery for Chiari’s.
I can’t answer your question on the expected time duration for a syrinx to disappear.
Some never disappear and some dissolve immediately.
The more important part of all of this is that you remain diligent about following up with your neurologist or neurosurgeon and have it routinely monitored.
I hope this helps,
Best regards,
JKL, M.D.
I will try to make this as brief as possible. I have suffered from migraines since childhood. In October 2000, I had fractured my left and spent 4 1/2 months in the hospital from a fall I had endured while enlisted with the US Navy. After many x-rays, and finally a bone scan, it was determined that I had a several left hip fractures, and syringomyelia. The fractures would heal on their own, so surgery was not needed, but the syringomyelia was enough to discharge me with a Med-Board. After returning home, in severe hip and back pain, I was then diagnosed with "central pain disorder", which would sometimes incapacitate my body, making me immobile, but in severe pain. Pain Management had helped for a while, then I became pregnant and my body changed drastically. My hip had pretty much healed on its own. Because my OB/GYN didn't know how my syringomeylia would react to my pregnancy, I was put on bed rest for the duration of my pregnancy. And finally I had a C-Section, due to the fact that I could not give birth naturally, nor have an epideral-ly controlled c-section.
After my first pregnancy, I was in a lot of pain, with specific movements of my body. A particular turn, and a sharp shooting pain would engulf one side of my body, and wouldn't cease for a few hours. Once this pain, too had been kept up with by medications, I got off the medicine, and was fine. This whole situation had duplicated itself with my second pregnancy, but this time, the pain endured throughout my pregnancy, and caused false pre-term labor, and finally a c-section was performed earlier than expected.
Now it is nearly 7 years later, and I can't even pick up a 5 pound bag of sugar, without screaming out in agony because of the pain I go through. I'm tired all the time, both of my hips hurt with dull achy pains that run down both of my legs, then jump to sharp nail-biting fits. I am the only source of income for my family, so going to work with pain has become part of my routine.
My question is................... could I have been mis-diagnosed for all this pain I feel. I have had several MRI's done over the years to keep up with my syringomyelia, but according to the neurologist, that I finally got in to see this year, the syringomyelia couldn't possibly be causing the pain that I am in. My migraines have increased in length, and frequency.
I wonder if a Cat Scan would show anything, something to explain why I am in pain?