Do you sometimes feel numbness and severe pain in your neck, shoulders, or arms? Or do you have a loss of sensation in parts of your body? If you have more than one of these symptoms, it could be due to a rare condition called syringomyelia, which we are going to talk about. Don't worry, this isn't something that happens to many people. But it's important to keep this simple from the start.
What exactly is this syringomyelia?
Simply put, this is the name given to the formation of a fluid-filled sac, or cyst, inside our spinal cord. Doctors call this fluid-filled sac a 'syrinx'. This is why some people also call this condition Hydromyelia, Syringohydromyelia.
Most of the time, you may not even notice it. But sometimes, if this cyst grows over time, it can start to press on and damage the delicate nerves in your spine. In that case, treatment is needed.
This condition is most common among adults between the ages of 20 and 40. It is also more common in men than women.
What could be the symptoms?
The symptoms of this depend on where the cyst is located in the spine and how big it is. Over time, as the cyst grows, it can damage the nerves in the spine. That's when the problems begin.
Often, symptoms appear very slowly, over many years. However, sometimes symptoms can appear suddenly after an accident, such as a fall.
The table below lists some of the main symptoms that can be seen.
| Symptom category | Things to see |
|---|---|
| Pain and sensation | Pain, numbness, burning, or a stabbing sensation in the neck, shoulders, arms, and hands. Loss of sensation of heat/cold, such as hot water or ice, in the hands, fingers, and upper chest. |
| Muscle weakness | Muscle weakness (especially in the arms and shoulders), difficulty walking due to muscle stiffness, and loss of reflexes. |
| Body changes | Curvature of the spine, a condition we call scoliosis . Changes or difficulties in controlling the toilet or urine. |
| Other features | Headaches, excessive sweating, abnormal changes in blood pressure, sexual problems, and uncoordinated movements. |
Sometimes, if this cyst damages a nerve that controls the muscles of our face and eyes, a condition called Horner syndrome can occur. In this case, you may see things like drooping of the eyelid on the affected side of the face, a small pupil, and decreased sweating on that side.
Why does something like this happen?
Imagine that our brain and spinal cord are surrounded by a special fluid called cerebrospinal fluid. When this fluid flows normally, there is no problem. But if for some reason the path of this fluid is blocked, that fluid can accumulate inside the spinal cord and form the cyst we mentioned. There are two main categories of causes for this.
Congenital Causes
This is the most common cause. When some babies are born, the lower part of their brain (cerebellum) may be pushed down towards the spine. Doctors call this a Chiari I malformation . This blocks the flow of fluid and causes a cyst to form. However, not everyone with this Chiari I malformation will develop syringomyelia . Symptoms usually appear between the ages of 25 and 40.
Acquired Causes
Sometimes this condition can also be caused by damage to the spine, meaning something that happens after birth.
- Spinal cord injury
- Infections such as meningitis
- Spinal tumor
- Swelling of the membranes covering the spine
- A condition called Tethered Spinal Cord (in which the lower end of the spinal cord is abnormally pulled).
Very rarely, it can develop without any obvious cause. Doctors call it idiopathic syringomyelia .
How exactly do you find this?
The best and most definitive way to diagnose this condition is to have an MRI (Magnetic Resonance Imaging) scan . This scans your brain and entire spine. This can clearly show whether the cyst is there, how big it is, and what caused it (e.g., a Chiari malformation).
Sometimes, this condition is discovered incidentally during an MRI for another reason. In some cases, your doctor may also recommend a CT (Computed Tomography) scan .
How is it treated?
The treatment you receive will depend on whether you have symptoms and how severe they are. Not everyone is given the same treatment.
If there are no or minimal symptoms: observation
If you have no symptoms or only mild symptoms, you may not need any major treatment. But your doctor will likely check you regularly . They will do MRI scans at regular intervals to check for any new symptoms or to see if the cyst is getting bigger. They will also advise you to avoid strenuous activities, such as lifting heavy objects. They may prescribe pain medication and refer you to physical therapy.
If symptoms are severe: Surgery
If your symptoms are severe enough to interfere with your daily life, you may need surgery. The main goal of surgery is to restore the blocked fluid flow.
The type of surgery you have will depend on what is causing your condition. For example, if the cause is Chiari I malformation, your doctor may perform a procedure called posterior fossa decompression . This involves removing a small piece of bone from the back of the skull and the top of the spine to make more room for the brain and nerves. This relieves the pressure and allows fluid to flow normally.
It is very important to discuss the risks and benefits of surgery with your doctor before making a decision.
What happens after treatment?
It's good to be aware of this too. Sometimes, even after surgery, the problem isn't completely resolved. The fluid can build up again. Also, the damage to the nerves can sometimes be permanent.
Therefore, it is essential to maintain regular contact with your doctor even after surgery. You should have regular MRI scans to check for recurrence of the cyst. This is a condition that requires long-term management. Therefore, it is very important to follow your doctor's instructions.
Take-Home Message
- Syringomyelia is a rare condition in which a fluid-filled cyst forms inside the spinal cord.
- Pain in the neck, arms, numbness, and especially loss of sensation to heat/cold may be the main symptoms.
- The main cause of this is a blockage of fluid flow in the brain and spinal cord. The most common birth defect is Chiari I malformation.
- An MRI scan is essential for diagnosis.
- Treatment options include observation if there are no symptoms, and surgery if symptoms are severe. Talk to your doctor about any symptoms you have.
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