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Syringomyelia, isolated

MedGen UID:
1622554
Concept ID:
C4538540
Disease or Syndrome
Synonym: SYRINGOMYELIA, NONCOMMUNICATING ISOLATED
 
Monarch Initiative: MONDO:0008525
OMIM®: 186700

Definition

Syringomyelia (Greek: 'syrinx,' pipe, and 'myelos,' marrow) is a tubular cavity in the spinal cord. It can occur sporadically in association with spinal cord tumors, inflammatory arachnoiditis, or posttraumatically. It is rarely idiopathic (less than 1% of cases). The vast majority of cases of syringomyelia are cervical, noncommunicating, and associated with an abnormality at the foramen magnum, particularly the Chiari malformation type I (CM1; 118420), as well as basilar impression (109500) and Dandy-Walker malformation (220200) (Speer et al., 2003; Levine, 2004); these cases have shown familial segregation. The form of syringomyelia discussed here is 'noncommunicating' with the fourth ventricle, but may communicate with the subarachnoid space. In contrast, 'communicating' syringomyelia, or 'hydromelia,' opens rostrally into the fourth ventricle and almost always occurs in children with hydrocephalus, Chiari malformation type II (CM2; 207950), and spina bifida (see 182940) (Levine, 2004). [from OMIM]

Clinical features

From HPO
Neck pain
MedGen UID:
861
Concept ID:
C0007859
Sign or Symptom
An unpleasant sensation characterized by physical discomfort (such as pricking, throbbing, or aching) localized to the neck.
Urinary incontinence
MedGen UID:
22579
Concept ID:
C0042024
Finding
Loss of the ability to control the urinary bladder leading to involuntary urination.
Limb muscle weakness
MedGen UID:
107956
Concept ID:
C0587246
Finding
Reduced strength and weakness of the muscles of the arms and legs.
Areflexia of upper limbs
MedGen UID:
388832
Concept ID:
C2674177
Finding
Inability to elicit tendon reflexes in the upper limbs.
Dysarthria
MedGen UID:
8510
Concept ID:
C0013362
Mental or Behavioral Dysfunction
Dysarthric speech is a general description referring to a neurological speech disorder characterized by poor articulation. Depending on the involved neurological structures, dysarthria may be further classified as spastic, flaccid, ataxic, hyperkinetic and hypokinetic, or mixed.
Horner syndrome
MedGen UID:
5616
Concept ID:
C0019937
Disease or Syndrome
An abnormality resulting from a lesion of the sympathetic nervous system characterized by a combination of unilateral ptosis, miosis, and often ipsilateral hypohidrosis and conjunctival injection.
Paresthesia
MedGen UID:
14619
Concept ID:
C0030554
Disease or Syndrome
Abnormal sensations such as tingling, pricking, or numbness of the skin with no apparent physical cause.
Babinski sign
MedGen UID:
19708
Concept ID:
C0034935
Finding
Upturning of the big toe (and sometimes fanning of the other toes) in response to stimulation of the sole of the foot. If the Babinski sign is present it can indicate damage to the corticospinal tract.
Syringomyelia
MedGen UID:
21449
Concept ID:
C0039144
Disease or Syndrome
Dilated, glial-lined cavity in spinal cord. This cavity does not communicate with the central canal, and usually is between the dorsal columns unilaterally or bilaterally along the side of the cord.
Unsteady gait
MedGen UID:
68544
Concept ID:
C0231686
Finding
A shaky or wobbly manner of walking.
Chiari type I malformation
MedGen UID:
196689
Concept ID:
C0750929
Congenital Abnormality
Arnold-Chiari type I malformation refers to a relatively mild degree of herniation of the posteroinferior region of the cerebellum (the cerebellar tonsils) into the cervical canal with little or no displacement of the fourth ventricle. It is characterized by one or both pointed (not rounded) cerebellar tonsils that project 5 mm below the foramen magnum, measured by a line drawn from the basion to the opisthion (McRae Line)
Gait ataxia
MedGen UID:
155642
Concept ID:
C0751837
Sign or Symptom
A type of ataxia characterized by the impairment of the ability to coordinate the movements required for normal walking. Gait ataxia is characteirzed by a wide-based staggering gait with a tendency to fall.
Lower limb spasticity
MedGen UID:
220865
Concept ID:
C1271100
Finding
Spasticity (velocity-dependent increase in tonic stretch reflexes with increased muscle tone and hyperexcitable tendon reflexes) in the muscles of the lower limbs, hips, and pelvis
Lower limb hyperreflexia
MedGen UID:
322973
Concept ID:
C1836696
Finding
Scoliosis
MedGen UID:
11348
Concept ID:
C0036439
Disease or Syndrome
The presence of an abnormal lateral curvature of the spine.
Enlarged sagittal diameter of the cervical canal
MedGen UID:
870664
Concept ID:
C4025118
Finding
Abnormal foramen magnum morphology
MedGen UID:
871208
Concept ID:
C4025687
Anatomical Abnormality
Any abnormality of the foramen magnum.
Nystagmus
MedGen UID:
45166
Concept ID:
C0028738
Disease or Syndrome
Rhythmic, involuntary oscillations of one or both eyes related to abnormality in fixation, conjugate gaze, or vestibular mechanisms.

Professional guidelines

PubMed

Ciaramitaro P, Massimi L, Bertuccio A, Solari A, Farinotti M, Peretta P, Saletti V, Chiapparini L, Barbanera A, Garbossa D, Bolognese P, Brodbelt A, Celada C, Cocito D, Curone M, Devigili G, Erbetta A, Ferraris M, Furlanetto M, Gilanton M, Jallo G, Karadjova M, Klekamp J, Massaro F, Morar S, Parker F, Perrini P, Poca MA, Sahuquillo J, Stoodley M, Talamonti G, Triulzi F, Valentini MC, Visocchi M, Valentini L; International Experts Jury of the Chiari Syringomyelia Consensus Conference, Milan, November 11-13, 2019
Neurol Sci 2022 Feb;43(2):1327-1342. Epub 2021 Jun 15 doi: 10.1007/s10072-021-05347-3. PMID: 34129128
Massimi L, Peretta P, Erbetta A, Solari A, Farinotti M, Ciaramitaro P, Saletti V, Caldarelli M, Canheu AC, Celada C, Chiapparini L, Chieffo D, Cinalli G, Di Rocco F, Furlanetto M, Giordano F, Jallo G, James S, Lanteri P, Lemarchand C, Messing-Jünger M, Parazzini C, Paternoster G, Piatelli G, Poca MA, Prabahkar P, Ricci F, Righini A, Sala F, Sahuquillo J, Stoodley M, Talamonti G, Thompson D, Triulzi F, Zucchelli M, Valentini L; International Experts - Jury of the Chiari & Syringomyelia Consensus Conference, “Milan, November 11–13, 2019”
Neurol Sci 2022 Feb;43(2):1311-1326. Epub 2021 Jun 7 doi: 10.1007/s10072-021-05317-9. PMID: 34097175Free PMC Article
Joseph RN, Batty R, Raghavan A, Sinha S, Griffiths PD, Connolly DJ
Br J Neurosurg 2013 Oct;27(5):683-6. Epub 2013 Mar 9 doi: 10.3109/02688697.2013.771728. PMID: 23472665

Recent clinical studies

Etiology

Zhang W, Sha S, Xu L, Liu Z, Qiu Y, Zhu Z
BMC Musculoskelet Disord 2016 Apr 27;17:189. doi: 10.1186/s12891-016-1026-7. PMID: 27121616Free PMC Article
Joseph RN, Batty R, Raghavan A, Sinha S, Griffiths PD, Connolly DJ
Br J Neurosurg 2013 Oct;27(5):683-6. Epub 2013 Mar 9 doi: 10.3109/02688697.2013.771728. PMID: 23472665
McGirt MJ, Nimjee SM, Fuchs HE, George TM
Neurosurgery 2006 Jul;59(1):140-6; discussion 140-6. doi: 10.1227/01.NEU.0000219841.73999.B3. PMID: 16823310

Diagnosis

Ramírez N, Olivella G, Cuneo A, Carrazana L, Ramírez N, Iriarte I
Spine Deform 2020 Aug;8(4):663-668. Epub 2020 Feb 18 doi: 10.1007/s43390-020-00065-w. PMID: 32072489
Zhang W, Sha S, Xu L, Liu Z, Qiu Y, Zhu Z
BMC Musculoskelet Disord 2016 Apr 27;17:189. doi: 10.1186/s12891-016-1026-7. PMID: 27121616Free PMC Article
Joseph RN, Batty R, Raghavan A, Sinha S, Griffiths PD, Connolly DJ
Br J Neurosurg 2013 Oct;27(5):683-6. Epub 2013 Mar 9 doi: 10.3109/02688697.2013.771728. PMID: 23472665
McGirt MJ, Nimjee SM, Fuchs HE, George TM
Neurosurgery 2006 Jul;59(1):140-6; discussion 140-6. doi: 10.1227/01.NEU.0000219841.73999.B3. PMID: 16823310

Prognosis

Ramírez N, Olivella G, Cuneo A, Carrazana L, Ramírez N, Iriarte I
Spine Deform 2020 Aug;8(4):663-668. Epub 2020 Feb 18 doi: 10.1007/s43390-020-00065-w. PMID: 32072489
Joseph RN, Batty R, Raghavan A, Sinha S, Griffiths PD, Connolly DJ
Br J Neurosurg 2013 Oct;27(5):683-6. Epub 2013 Mar 9 doi: 10.3109/02688697.2013.771728. PMID: 23472665
McGirt MJ, Nimjee SM, Fuchs HE, George TM
Neurosurgery 2006 Jul;59(1):140-6; discussion 140-6. doi: 10.1227/01.NEU.0000219841.73999.B3. PMID: 16823310
Amer TA, el-Shmam OM
Magn Reson Imaging 1997;15(4):397-403. doi: 10.1016/s0730-725x(96)00383-9. PMID: 9223040

Clinical prediction guides

Ramírez N, Olivella G, Cuneo A, Carrazana L, Ramírez N, Iriarte I
Spine Deform 2020 Aug;8(4):663-668. Epub 2020 Feb 18 doi: 10.1007/s43390-020-00065-w. PMID: 32072489
McGirt MJ, Nimjee SM, Fuchs HE, George TM
Neurosurgery 2006 Jul;59(1):140-6; discussion 140-6. doi: 10.1227/01.NEU.0000219841.73999.B3. PMID: 16823310

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