Syringomyelia: Symptoms, Causes, Treatment

What are the symptoms of syringomyelia?

Syringomyelia is a condition where a fluid-filled cavity, or syrinx, forms within the spinal cord. Symptoms can vary based on the size and location of the syrinx, but common symptoms include:

• Pain: Chronic pain in the neck, shoulders, or back is common. The pain can be dull, aching, or sharp and may be persistent or intermittent.
• Weakness: Muscle weakness, particularly in the arms and legs, can occur. This may affect coordination and the ability to perform everyday tasks.
• Sensory Loss: Reduced sensation or numbness, especially in the hands and arms. Some individuals may experience a “cape-like” distribution of sensory loss, where numbness affects the upper back and arms.
• Temperature Sensitivity: Abnormal sensitivity to temperature changes, including difficulty feeling hot or cold.
• Atrophy: Muscle wasting or atrophy in the hands or arms due to nerve damage.
• Spasticity: Increased muscle tone or spasticity, leading to stiffness and difficulty with movement.
• Hearing Loss: In some cases, syringomyelia can affect hearing, particularly if the syrinx affects the brainstem.
• Balance and Coordination Issues: Difficulty with balance and coordination, which may lead to problems with walking or maintaining posture.
• Headaches: Severe headaches, particularly at the back of the head, can occur if the syrinx causes increased pressure or irritation.
• Autonomic Dysfunction: Changes in blood pressure, sweating, or other autonomic functions can occur in advanced cases.

The symptoms of syringomyelia can gradually worsen over time, and early diagnosis and treatment are important to manage the condition and prevent further neurological damage.

What are the causes of syringomyelia?

Syringomyelia is caused by the formation of a fluid-filled cavity, or syrinx, within the spinal cord. Several factors can contribute to the development of syringomyelia:

• Chiari Malformation: The most common cause of syringomyelia is Chiari malformation, particularly Type I. In this condition, the cerebellum (part of the brain) extends into the spinal canal, obstructing the flow of cerebrospinal fluid and leading to the formation of a syrinx.
• Spinal Cord Injury: Trauma or injury to the spinal cord can cause the development of a syrinx. This may occur from accidents or severe falls.
• Spinal Tumors: Tumors within or near the spinal cord can interfere with the normal flow of cerebrospinal fluid, leading to the formation of a syrinx.
• Inflammatory Conditions: Conditions that cause inflammation of the spinal cord, such as multiple sclerosis or infections, can lead to syringomyelia.
• Congenital Abnormalities: Some individuals may be born with abnormalities in the spinal cord that predispose them to syringomyelia.
• Post-Surgical Complications: In rare cases, syringomyelia can develop as a complication following spinal surgery or other medical procedures involving the spinal cord.
• Genetic Factors: While less common, there may be a genetic predisposition in some cases, particularly in association with Chiari malformation.

Understanding the underlying cause of syringomyelia is crucial for determining the appropriate treatment and management strategy.

What is the treatment for syringomyelia?

Treatment for syringomyelia aims to address the underlying cause, manage symptoms, and prevent progression. The approach depends on the size, location of the syrinx, and the severity of symptoms. Common treatments include:

• Surgical Intervention: Surgery is often necessary if the syringomyelia is causing significant symptoms or complications. The most common surgical procedure is decompression of the Chiari malformation if present. This involves removing a portion of the skull to relieve pressure on the spinal cord and restore cerebrospinal fluid flow. In cases where the syrinx is caused by a spinal cord tumor or injury, surgery may focus on removing the tumor or repairing the injury.
• Shunt Placement: A shunt is a tube that can be inserted into the syrinx to drain excess fluid and reduce pressure. This procedure helps to alleviate symptoms and prevent further damage.
• Medications: Pain relief and management of other symptoms may be achieved through medications. These may include painkillers, muscle relaxants, or medications to manage neuropathic pain.
• Physical Therapy: Physical therapy can help improve strength, coordination, and mobility. Therapy may focus on exercises to enhance muscle function and prevent complications related to muscle weakness and atrophy.
• Monitoring and Regular Follow-ups: In some cases, especially if symptoms are mild or the syrinx is small and not causing significant problems, regular monitoring with imaging studies (such as MRI) and clinical evaluations may be recommended to track any changes over time.

The treatment plan for syringomyelia is tailored to the individual, considering the specific characteristics of the syrinx and the overall health of the patient. Consulting with a neurologist or neurosurgeon is crucial for determining the most appropriate treatment strategy.