eMedicine Specialties > Physical Medicine and Rehabilitation > Spinal Cord Injury

Posttraumatic Syringomyelia: Differential Diagnoses & Workup

Author: Lance Goetz, MD, Staff Physician, Spinal Cord Injury Center, Dallas Veterans Affairs Medical Center; Associate Professor of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center at Dallas
Coauthor(s): Michael Priebe, MD, Associate Professor, Department of Physical Medicine and Rehabilitation, Mayo Clinic of Rochester, Minnesota
Contributor Information and Disclosures

Updated: Oct 22, 2009

Differential Diagnoses

Autonomic Dysreflexia in Spinal Cord Injury
Spasticity
Carpal Tunnel Syndrome
Spinal Cord Injury and Aging
Cervical Myofascial Pain
Swallowing Disorders
Cervical Spondylosis
Traumatic Brachial Plexopathy
Myofascial Pain
Rotator Cuff Disease

Other Problems to Be Considered

Cervical, thoracic, or lumbar radiculopathy
Spinal cord tumor
Spinal cord infarct
Epidural abscess or hematoma
Tethered cord syndrome
Progressive noncystic myelopathy
Spinal instability

Workup

Laboratory Studies

  • Pulmonary function tests, especially vital capacity, should be ordered on any patient with symptoms or suggested respiratory impairment. Serial studies are useful to document and monitor for progression.
  • No specific laboratory blood studies have proven useful in the diagnosis or monitoring of PTS.

Imaging Studies

  • Magnetic resonance imaging (MRI), myelography-enhanced computed tomography (CT-myelogram), and plain radiographs of the spine are useful in the diagnosis and management of PTS.
  • MRI is the preferred initial imaging study for the diagnosis of PTS. Most PTS develops around the site of the original spinal cord lesion. T1 and T2 sequences provide differentiation between CSF and normal spinal cord tissue and areas of spinal cord edema, myelomalacia, or gliosis. Serial examinations are necessary to evaluate for changes in cavity size over time. In addition, there is a marked lack of correlation between cavity size and severity of clinical symptoms. (See images below and Images 5-6.)
T1-weighted magnetic resonance imaging (MRI) scan...

T1-weighted magnetic resonance imaging (MRI) scan of a slender syrinx (arrow) extending from the C5 vertebral level. This syrinx extends beyond the image to an area of spinal cord disruption at the T3 vertebral level.

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T1-weighted magnetic resonance imaging (MRI) scan...

T1-weighted magnetic resonance imaging (MRI) scan of a slender syrinx (arrow) extending from the C5 vertebral level. This syrinx extends beyond the image to an area of spinal cord disruption at the T3 vertebral level.


Same patient as in image above, with the magnetic...

Same patient as in image above, with the magnetic resonance imaging (MRI) scan slightly farther down the cervicothoracic region of the spine

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Same patient as in image above, with the magnetic...

Same patient as in image above, with the magnetic resonance imaging (MRI) scan slightly farther down the cervicothoracic region of the spine

  • CT-myelography delineates the extent of the syrinx cavity, arachnoid scarring, and tethering of the spinal cord. This study demonstrates the extent of obstruction to CSF flow.
  • Radiographs of the spine delineate spinal deformities such as fractures, dislocations, and abnormal spinal kyphotic or lordotic changes. Flexion/extension views assist in evaluation of spinal stability.
  • Ultrasonography may be used intraoperatively after laminectomy to visualize syrinx cavities and septations.

Other Tests

  • Serial quantitative strength measurements including pinch and grip tests or hand-held myometry are useful in confirming progression of weakness.
  • Calculation of the central motor conduction time using motor evoked potentials is useful in monitoring PTS; however, this technique is not widely available.
  • Standard electromyographic techniques, including nerve conduction studies, F-wave latencies, and needle electromyography (EMG), are less sensitive and specific in detecting PTS. Needle EMG may demonstrate a variety of abnormalities, including continuous motor unit activity, synchronous motor unit potentials, myokymic discharges, segmental and propriospinal myoclonus, and respiratory synkinesis. However, as these studies are best used to exclude other causes for the person's symptoms.

Histologic Findings

On pathologic section, cavitation of the gray matter is seen within the spinal cord. This phenomenon may involve the central canal or may be located eccentrically. An inner layer of gliotic tissue usually is present. The gray matter between the dorsal horns and posterior columns often is involved, possibly because of its relative avascularity and lack of connective tissue. Multiple cyst cavities, separated by complete or partial septae, are often present.

More on Posttraumatic Syringomyelia

Overview: Posttraumatic Syringomyelia
Differential Diagnoses & Workup: Posttraumatic Syringomyelia
Treatment & Medication: Posttraumatic Syringomyelia
Follow-up: Posttraumatic Syringomyelia
Multimedia: Posttraumatic Syringomyelia
References
Further Reading
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Keywords

posttraumatic syringomyelia, syringomyelia, SCI, spinal cord injury, syrinx, spinal cyst, spinal cysts, spinal cord cyst, syringomyelia symptoms, syringomyelia surgery, posttraumatic spinal cord injury

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Contributor Information and Disclosures

Author

Lance Goetz, MD, Staff Physician, Spinal Cord Injury Center, Dallas Veterans Affairs Medical Center; Associate Professor of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center at Dallas
Lance Goetz, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Paraplegia Society, American Spinal Injury Association, Association of Academic Physiatrists, and International Spinal Cord Society
Disclosure: Nothing to disclose.

Coauthor(s)

Michael Priebe, MD, Associate Professor, Department of Physical Medicine and Rehabilitation, Mayo Clinic of Rochester, Minnesota
Michael Priebe, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Congress of Rehabilitation Medicine, American Paraplegia Society, American Spinal Injury Association, International Society of Physical and Rehabilitation Medicine, and International Spinal Cord Society
Disclosure: Nothing to disclose.

Medical Editor

Robert L Sheridan, MD, Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School
Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, and American College of Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Denise I Campagnolo, MD, MS, Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers
Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers
Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching; Genzyme Corporation Grant/research funds investigator; Biogen Idec Grant/research funds investigator; Genentech, Inc Grant/research funds investigator; Eli Lilly & Company Grant/research funds Novaritis; Novaritis  Novaritis; MSDx LLC Grant/research funds investigator; BioMS Technology Corp Grant/research funds investigator; Avanir Pharmaceuticals Grant/research funds investigator

 
 
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