eMedicine Specialties > Neurology > Movement and Neurodegenerative Diseases
Syringomyelia: Differential Diagnoses & Workup
Updated: Sep 24, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
Other Problems to Be Considered
Arnold-Chiari malformations
Cervical rib
Craniovertebral junction anomalies
Increased intracranial pressure
Intrinsic tumors of the spinal cord
Brainstem syndromes
Cervical disk syndromes
Workup
Laboratory Studies
- Cerebrospinal fluid analysis (not performed because of the risk of herniation)
- CSF pressure sometimes is elevated. A complete subarachnoid block may be noted.
- Cell count is rarely more than 10/mm3.
- Mild elevation of the CSF protein content occurs in half of these cases.
- In cases of subarachnoid block, CSF protein may exceed 100 mg/dL.
Imaging Studies
- Plain x-ray
- Plain films cannot detect the syrinx directly.
- Cervical canal commonly is widened, and the pedicles may be eroded.
- Flexion and extension films exclude bony instability.
- Basilar impression or craniovertebral anomalies may be demonstrated.
- Computerized tomography scan - Assists in detailed assessment and is especially useful in evaluation of bony spinal canal components
- Myelography
- Myelography is performed in special situations when MRI cannot be used.
- Widening of the cord and complete subarachnoid block may be observed.
- CT myelography
- Myelogram combined with immediate and delayed high-resolution CT scan also can be performed.
- Delayed CT scans are obtained 4-24 hours after the initial testing and can demonstrate cyst filling.
- Magnetic resonance imaging
- Imaging of the entire rostrocaudal extension of the cyst or cysts is important. Gadolinium-enhanced images are indicated if a tumor is suspected. Gadolinium-enhanced images are helpful in differentiating between scar or disk material associated with a syrinx, especially in postoperative or posttraumatic cases.
- MRI examination should include sagittal and transverse views in T1 and T2 images (see Media file 1). Proton density scans also can be helpful.
- Magnetic resonance angiography - Can be especially helpful in cases of syringomyelia associated with vascular lesions
- Cine phase-contrast MRI - Used to analyze CSF flow dynamics near the spinal cord cyst
- Real-time ultrasonography - Rarely utilized for imaging syringomyelia since the development of MRI; ultrasonography for this purpose is technically more feasible in young children or in thin patients.
Other Tests
- In neurophysiological assessment by somatosensory evoked potentials (SSEPs), low-amplitude or delayed responses are present in myelopathy.
- Neurophysiological assessment by motor evoked response may be more sensitive than SSEPs in the evaluation of spinal cord dysfunction.
Procedures
- The initial evaluation of patients suspected of having a spinal cord syrinx includes a comprehensive history and physical examination.
- Information obtained from examinations guides the imaging studies. Essential tests include plain radiographic series with dynamic views and high-resolution CT scan to assess the bony spinal canal.
- The most sensitive imaging test for soft tissue is an MRI scan. Gadolinium-enhanced images are also helpful in differentiating between tumor, scar, and disk material, especially in postoperative or posttraumatic cases.
Histologic Findings
The syringomyelic cavity, or syrinx, forms most commonly in the lower cervical region, particularly at the base of the posterior horn and extending into the central gray matter and anterior commissure of the cord.
Histopathologic findings include (1) cavitation of spinal cord gray matter, (2) syrinx continuous with or adjacent to the central canal, and (3) an inner layer of gliotic tissue.
In association with the syrinx, other pathological conditions such as tumors, vascular anomalies, or infective processes also may be evident.
More on Syringomyelia |
| Overview: Syringomyelia |
 Differential Diagnoses & Workup: Syringomyelia |
| Treatment & Medication: Syringomyelia |
| Follow-up: Syringomyelia |
| Multimedia: Syringomyelia |
| References |
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References
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Further Reading
Keywords
syringomyelia, hydromyelia, syrinx, syringohydromyelia, syringocephalus, syringobulbia
