Your QuestionI have syringomyelia. My physician believes that it is congenital, not post-traumatic. What are the different types of syringomyelia and how are they diagnosed?
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Generally, there are two forms of syringomyelia. In most cases, the disorder is related to an abnormality of the brain called a Chiari I malformation. This anatomic abnormality causes the lower part of the cerebellum to protrude from its normal location in the back of the head into the cervical or neck portion of the spinal canal. A syrinx may then develop in the cervical region of the spinal cord. Because of the relationship that was once thought to exist between the brain and spinal cord in this type of syringomyelia, physicians sometimes refer to it as communicating syringomyelia. Symptoms usually begin between the ages of 25 and 40 and may worsen with straining or any activity that causes cerebrospinal fluid (CSF) pressure to fluctuate suddenly. Some patients, however, may have long periods of stability. Some patients with this form of the disorder also have hydrocephalus, in which CSF accumulates in the skull, or a condition called arachnoiditis, in which a covering of the spinal cord--the arachnoid membrane--is inflamed.
The second major form of syringomyelia occurs as a complication of trauma, meningitis, hemorrhage, a tumor, or arachnoiditis. Here, the syrinx or cyst develops in a segment of the spinal cord damaged by one of these conditions. The syrinx then starts to expand. This is sometimes referred to as noncommunicating syringomyelia. Symptoms may appear months or even years after the initial injury, starting with pain, weakness, and sensory impairment originating at the site of trauma.
The primary symptom of post-traumatic syringomyelia is pain, which may spread upward from the site of injury. Symptoms, such as pain, numbness, weakness, and disruption in temperature sensation, may occur on one or both sides of the body. Syringomyelia can also adversely affect sweating, sexual function, and, later, bladder and bowel control.
Physicians now commonly use magnetic resonance imaging (MRI) to diagnose syringomyelia. The MR imager takes pictures of body structures, such as the brain and spinal cord, in vivid detail. This test will show the syrinx in the spine as well as other conditions, such as the presence of a tumor. MRI is safe, painless, and informative and has greatly improved the diagnosis of syringomyelia. MRI is the most sensitive imaging test for soft tissue. Gadolinium-enhanced images are also helpful in differentiating between tumor, scar, and disk material, especially in postoperative or posttraumatic cases.
- NINDS Syringomyelia Information Page. National Institute of Neurological Disorders and Stroke (NINDS). April 28, 2015; http://www.ninds.nih.gov/disorders/syringomyelia/syringomyelia.htm. Accessed 6/9/2015.
- Syringomyelia Fact Sheet. National Institute of Neurological Disorders and Stroke (NINDS). April 9, 2009; http://www.ninds.nih.gov/disorders/syringomyelia/detail_syringomyelia.htm. Accessed 4/30/2009.
- Al-Shatoury HAH, Galhorn AA, Wagner FC. Syringomyelia: Differential Diagnosis & Workup. Medscape Reference. September 15, 2014; http://emedicine.medscape.com/article/1151685-diagnosis. Accessed 7/9/2015.