Hemosiderin

[Pepper]

I have a pretty complicated history of cervical spine problems.  I had an AVM at C5 removed in 1988, and a corpectomy/fusion of C5-6, C6-7 last year due to a significant kyphosis.  I did well for about 3 months, then developed severe neck and left occipital pain.  I had a myelogram done in March of 2001, and after the myelogram I developed bilateral leg weakness in the morning, but the left leg is worse.  The left leg weakness has progressed since then, and some days it is so weak I can barely walk on it.  

I had a CT scan and MRI done in Aug and those films showed "obvious postoperative changes as well as what appears to be small hemosiderin as well as a syrinx in the cervical cord, especially behind the C4 body.  Additionally there is a significant amount of artifact from the screw plate at C5-7.  There are also apparently other cord changes within the cord itself.  The canal is also noted to be narrowed, particularly behind the C4 body.

My questions are what is hemosiderin?  Is it dangerous?  What about the syrinx?  Can anything be done about it?  Do you think the leg weakness is related?  Could any of this be arachnoiditis due to the myelogram?  Thank you in advance for your help.

[CCF-Neuro-M.D.-JT]

Hemosiderin is a normal breakdown product of blood.  As you had an AVM in the cervical spine, the hemosiderin is just chronic evidence that there was blood there at one time. Not dangerous.
The syrinx is a dilation of the central canal in your spinal cord.  We all have somewhat of a central canal in the middle of our cord. Yours is reported to be dilated which doesn't always mean something is wrong. If you have loss of pain and temperature sensation in a cape-like distribution over your arms, shoulder and back then you do need to see someone about it. Otherwise, it's asymptomatic. The leg weakness could certainly be due to arachnoiditis,a condition that has been reported with myelograms thought to be due to the dye causing changes in the spinal fluid or prior back surgeries. You definitely need to talk to your surgeon and go over the films with them. Best of luck.

[Pepper]

Can you tell me whether or not the syrinx is dangerous?  I've been doing some research on the internet and it looks like it's a very bad thing to have, and that progression is inevitable, and it can be fatal.  I have gotten worse (leg weakness, neck pain), and I'm scared.  I am seeing a neurologist next week, but in the meantime my mind is going crazy.

I also have severe myelomalacia from C3-7 or T1, and I've gotten conflicting reports from the radiologist and neurosurgeons.  Radiologists say I have myelomalcia, not a syrinx, the neurosurgeon says it is a syrinx.  If it is myelomalacia, is that going to progress too?  I appreciate any advice you can offer.