Clinicopathological Correlations in Syringomyelia Using Axial Magnetic Resonance Imaging

Milhorat, Thomas H.; Johnson, Richard W.; Milhorat, Robert H.; Capocelli, Anthony L.; Pevsner, Paul H.

doi:10.1097/00006123-199508000-00003

Cited by 32 publications

(33 citation statements)

References 10 publications

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“…By contrast, clinical signs are common if the cavity has a paracentral extension or is located eccentrically, and in such cases the signs are usually segmental and point to the location of the syrinx. 6 Here, MRI demonstrated a centrally located syrinx; in keeping with previous reports, clinical signs were limited. However, electrophysiologic data reveal the syrinx to be functionally eccentric.…”

Section: Go To Sectionsupporting

confidence: 90%

Clinical Reasoning: A 39-year-old man with abdominal cramps

Jaiser

Baker²,

Whittaker³

et al. 2013

Neurology

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A 39-year-old lawyer presented with intermittent spasms and pain in his abdominal muscles, particularly the right upper quadrant. These had occurred since his mid-20s and there had been long asymptomatic periods, including 8 years prior to the most recent 4-month exacerbation. Trivial movement triggered a spasm of the abdominal muscles, leading to severe pain, which made breathing uncomfortable and interfered with sleep. The symptoms subsided spontaneously after 4 to 5 days, leaving him with a sore abdomen for several weeks. Past attacks had also been precipitated by specific forms of repetitive exercise such as jogging. He described ill-defined numbness in the left leg, but denied any muscle twitching, weakness, back pain, or sphincter disturbance. There was no significant past medical or family history.On examination, cranial nerves were unremarkable. Tone and power were normal in upper and lower limbs. Tendon reflexes were brisk throughout, particularly in the lower limbs, where they were brisker on the left than the right; plantar responses were flexor. Abdominal reflexes were brisk on the right and absent on the left (video on the Neurology ® Web site at www. neurology.org). No fasciculations or myokymia were seen throughout. There was no demonstrable sensory asymmetry or loss to any modality in the lower limbs. Gait and cerebellar function were normal.Questions for consideration:

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Section: Go To Sectionsupporting

confidence: 90%

Clinical Reasoning: A 39-year-old man with abdominal cramps

Jaiser

Baker²,

Whittaker³

et al. 2013

Neurology

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“…1A), 10,27 characteristics of the syrinx (diameter, levels, location, and type; i.e., central, enlarged, or deviated) (Fig. 1B-D), 20,21 presence or absence of scoliosis, maximum axial width of the fourth ventricle, 30 odontoid retroversion (angle between the base of C-2 and its intersection with a line from the odontoid tip) ( Fig. 2A), retroflexion (angle formed between a line drawn through the odontoid synchondrosis and its intersection with a line drawn from the odontoid tip) (Fig.…”

Section: Preoperative Evaluationmentioning

confidence: 99%

A points-based algorithm for prognosticating clinical outcome of Chiari malformation Type I with syringomyelia: results from a predictive model analysis of 82 surgically managed adult patients

Thakar

Sivaraju

Jacob

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEAlthough various predictors of postoperative outcome have been previously identified in patients with Chiari malformation Type I (CMI) with syringomyelia, there is no known algorithm for predicting a multifactorial outcome measure in this widely studied disorder. Using one of the largest preoperative variable arrays used so far in CMI research, the authors attempted to generate a formula for predicting postoperative outcome.METHODSData from the clinical records of 82 symptomatic adult patients with CMI and altered hindbrain CSF flow who were managed with foramen magnum decompression, C-1 laminectomy, and duraplasty over an 8-year period were collected and analyzed. Various preoperative clinical and radiological variables in the 57 patients who formed the study cohort were assessed in a bivariate analysis to determine their ability to predict clinical outcome (as measured on the Chicago Chiari Outcome Scale [CCOS]) and the resolution of syrinx at the last follow-up. The variables that were significant in the bivariate analysis were further analyzed in a multiple linear regression analysis. Different regression models were tested, and the model with the best prediction of CCOS was identified and internally validated in a subcohort of 25 patients.RESULTSThere was no correlation between CCOS score and syrinx resolution (p = 0.24) at a mean ± SD follow-up of 40.29 ± 10.36 months. Multiple linear regression analysis revealed that the presence of gait instability, obex position, and the M-line–fourth ventricle vertex (FVV) distance correlated with CCOS score, while the presence of motor deficits was associated with poor syrinx resolution (p ≤ 0.05). The algorithm generated from the regression model demonstrated good diagnostic accuracy (area under curve 0.81), with a score of more than 128 points demonstrating 100% specificity for clinical improvement (CCOS score of 11 or greater). The model had excellent reliability (κ = 0.85) and was validated with fair accuracy in the validation cohort (area under the curve 0.75).CONCLUSIONSThe presence of gait imbalance and motor deficits independently predict worse clinical and radiological outcomes, respectively, after decompressive surgery for CMI with altered hindbrain CSF flow. Caudal displacement of the obex and a shorter M-line–FVV distance correlated with good CCOS scores, indicating that patients with a greater degree of hindbrain pathology respond better to surgery. The proposed points-based algorithm has good predictive value for postoperative multifactorial outcome in these patients.

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“…[1] Spinal spondylosis is an extremely common condition that has only rarely been described as a cause of syringomyelia. [2][3][4][5] T. Milhorat et al reported 115 cases with non-neoplastic spinal cord syrinxes and there was only one patient whose syringomyelia was initially caused by cervical spondylosis. [2] Major theories of formation of the cyst are as follows: (1) Hydrodynamic theory of Gardner [6]: systolic pulsations are transmitted with each heartbeat from the intracranial cavity to the central canal.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5] T. Milhorat et al reported 115 cases with non-neoplastic spinal cord syrinxes and there was only one patient whose syringomyelia was initially caused by cervical spondylosis. [2] Major theories of formation of the cyst are as follows: (1) Hydrodynamic theory of Gardner [6]: systolic pulsations are transmitted with each heartbeat from the intracranial cavity to the central canal. (2) Williams' theory [7]: maneuvers that raise cerebrospinal fluid (CSF) pressure cause "hydrodissection" through the spinal cord tissue.…”

Section: Discussionmentioning

confidence: 99%

Syringomyelia associated with Cervical Spondylosis: A case report

Samancı¹,

Çelik²

2014

Romanian Neurosurgery

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Although cervical spondylosis is an extremely common condition causing spinal cord compression, it is rarely involved in syringomyelia formation.Here we describe a case of syringomyelia associated with cervical spondylosis.Key words: Cervical spondylosis, Surgery, Syringomyelia. Case HistoryA 57-year-old woman presented to our outpatient clinic complaining of left arm pain and weakness, progressing over 2 months. On neurological examination, there was muscle atrophy and dissociated sensory loss in the right arm and hand, and exaggerated reflexes in the upper limbs. The patient was subsequently referred for magnetic resonance imaging (MRI). Sagittal and axial T1 and T2 weighted sequences through the cervical and thoracic spine were performed. This demonstrated degenerative changes at C5-6 with a left foraminal disc protrusion compressing thecal sac. (Figures 1 and 2) An unexpected cord syrinx was noted extending from C5 inferiorly to T1. (Figures 1 and 3

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Clinicopathological Correlations in Syringomyelia Using Axial Magnetic Resonance Imaging

Cited by 32 publications

References 10 publications

Clinical Reasoning: A 39-year-old man with abdominal cramps

Clinical Reasoning: A 39-year-old man with abdominal cramps

A points-based algorithm for prognosticating clinical outcome of Chiari malformation Type I with syringomyelia: results from a predictive model analysis of 82 surgically managed adult patients

Syringomyelia associated with Cervical Spondylosis: A case report

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