Spinal spondylosis is an extremely common condition that has only rarely been described as a cause of syringomyelia. We describe a case of syringomyelia associated with cervical spondylosis admitted at our division an...Spinal spondylosis is an extremely common condition that has only rarely been described as a cause of syringomyelia. We describe a case of syringomyelia associated with cervical spondylosis admitted at our division and treated by our institute. It is the case of a 66-yearold woman. At our observation she was affected by moderate-severe spastic tetraparesis. T2-weighted magnetic resonance imaging(MRI) showed an hyperintense signal within spinal cord from C3 to T1 with a more sharply defined process in the inferior cervical spinal cord. At the same level bulging discs, facets and ligamenta flava hypertrophy determined a compression towards subarachnoid space and spinal cord. Spinal cord compression was more evident in hyperextension rather than flexion. A 4-level laminectomy and subsequent posterior stabilization with intra-articular screws was executed. At 3-mo follow up there was a regression of tetraparesis but motor deficits of the lower limbs residuated. At the same follow up postoperative MRI was executed. It suggested enlargement of the syrinx. Perhaps hyperintensity within spinal cord appeared "bounded" from C3 to C7 with clearer margins. At the level of surgical decompression, subarachnoid space and spinal cord enlargement were also evident. A review of the literature was executed using Pub Med database. The objective of the research was to find an etiopathological theory able to relate syringomyelia with cervical spondylosis. Only 6 articles have been found. At the origin of syringomyelia the mechanisms of compression and instability are proposed. Perhaps other studies assert the importance of subarachnoid space regard cerebrospinal fluid(CSF) dynamic. We postulate that cervical spine instability may be the cause of multiple microtrauma towards spinal cord and consequently may damage spinal cord parenchyma generating myelomalacia and consequently syrinx. Otherwise the hemorrhage within spinal cord central canal can cause an obstruction of CSF outflow, finally generating the syrinx. On the other hand in cervical spondylosis the stenotic elements can affect subarachnoid space. These elements rubbing towards spinal cord during movements of the neck can generate arachnoiditis, subarachnoid hemorrhages and arachnoid adhesions. Analyzing the literature these "complications" of cervical spondylosis are described at the origin of syringomyelia. So surgical decompression, enlarging medullary canal prevents rubbings and contacts between the bone-ligament structures of the spine towards spinal cord and subarachnoid space therefore syringomyelia. Perhaps stabilization is also necessary to prevent instability of the cervical spine at the base of central cord syndrome or syringomyelia. Finally although patients affected by central cord syndrome are usually managed conservatively we advocate, also for them, surgical treatment in cases affected by advanced state of the symptoms and MRI.展开更多
Neuropathic arthropathy of the shoulder is a rare disorder characterized by joint degeneration, and is associated with loss of sensory innervation. Syringomyelia is a disease in which fluid-containing cavities(syrinxe...Neuropathic arthropathy of the shoulder is a rare disorder characterized by joint degeneration, and is associated with loss of sensory innervation. Syringomyelia is a disease in which fluid-containing cavities(syrinxes) form within the spinal cord. Here, we report a case of neuropathic arthropathy of the shoulder secondary to syringomyelia in a 40-year-old woman. X-rays of the left shoulder revealed damage to bone and joint architecture. Blood tests indicated vitamin D deficiency and secondary hyperparathyroidism. Magnetic resonance imaging of the cervical spine showed a large syrinx from the second cervical spine to the second dorsal spine. Although neuropathic arthropathy is uncommon, it should be considered in cases of unexplained pain, discomfort, or limited range of motion of the affected joint. Symptoms related to the affected joint may precede or overshadow neurological deficits. Appropriate radiological examinations and diagnoses are imperative to prevent misdiagnosis or undetected bone and joint disorders.展开更多
BACKGROUND Charcot neuroarthropathy(CN)is a systemic disease characterized by progressive bone loss and destruction,which is usually closely related to diabetes,HIV,etc.However,CN caused by syringomyelia accounts for ...BACKGROUND Charcot neuroarthropathy(CN)is a systemic disease characterized by progressive bone loss and destruction,which is usually closely related to diabetes,HIV,etc.However,CN caused by syringomyelia accounts for only 5%of CN cases;the shoulder and elbow are most often involved,and the hip joint is rarely affected.As a rare factor,cervical spondylotic myelopathy(CSM)can be associated with syringomyelia,which is scarcely reported in the literature.Here,we present the first case report to date of CN of the hip caused by syringomyelia secondary to CSM.CASE SUMMARY We describe a 76-year-old male patient who was diagnosed with CSM due to neck pain and weakness of limbs 16 years ago.Four years ago,he noticed recurrent swelling of the right hip with pain and was diagnosed with degenerative arthritis.Recently,however,his symptoms gradually worsened,and because of progressive pain,destabilization and weakness of the right hip,he was admitted to our hospital.Through systematic physical,radiographic and laboratory examinations,we finally reached a diagnosis:CN of the right hip associated with syringomyelia secondary to CSM.After comprehensive evaluation of the patient's condition,we performed right total hip arthroplasty.During the follow-up,the patient felt well clinically and could walk independently with a knee brace.CONCLUSION We suggest a possible etiological association between CSM and syringomyelia,which may reflect a potential pathogenesis of CN.We encourage clinicians to actively carry out a detailed medical history and comprehensive physical and imaging examinations in patients with joint lesions,especially chronic shoulder neck pain,to rule out the possibility of this association,which plays a crucial role in the early diagnosis of CN.Arthroplasty may no longer be an absolute contraindication to surgical treatment of CN.Reasonable selection of the surgical strategy can markedly improve the clinical symptoms and quality of life of patients.展开更多
Objective： To describe the MRI findings and discuss the pathogenesis formation mechanism of syringomyelia in the patients after spine surgical operation. Methods： Totally 13 patients were been enrolled in the study....Objective： To describe the MRI findings and discuss the pathogenesis formation mechanism of syringomyelia in the patients after spine surgical operation. Methods： Totally 13 patients were been enrolled in the study. Before operation, none of our patients presented with spinal cord syringomyelia. The mean follow-up duration was 6 years （range 2-10 months） by MRI. Four of the 13 patients after spinal cord tumor removed operation, 3 patients after spinal trauma operation, 2 cases had scoliosis before, 2 cases were cervical spondylotic myelopathy and 2 cases had tethered cord syndrome before operation. MR features of pre- and post-operation on all patients were been studied in contrast with surgical results and clinical symptoms. The radiology diagnostic was made by 3 different radiologists respectively. The characteristics of length, width, signals, shape of cavity and spinal cord position as well as subarachnoid shape were focused on. Results： All the patients had no syringomyelia on MRI before operation. The spinal cord of 7 patients showed persist compression and 2 patients had tethered cord before operation. MRI features of syringomyelia after operation in our cases showed longitudinal cavity with syrinx fluid had T1 and T2 relation characteristics of cerebrospinal fluid （CSF）. The mean length was 5.5 spinal segment, 4 cord of 13 patients presented cord compressed from anterior materials, 4 occurred postoperative adhesion to the back of lumbar spinal canal and spinal cord of 1 cases clung to the front wall of cervical spinal canal. Conclusion： The mechanism of syringomyelia in the patients after spinal surgical intervention may be the persisting compression or intention of the spinal cord in the period of pre- or post-operation. The edema, cyst, malacia of spinal cord are the most important lesions and risk factors resulted in the syringomyelia.展开更多
The association between cerebellar medulloblastoma and syringomyelia is uncommon and only found in pediatric patients.To date,adult medulloblastoma associated with syringomyelia has not been reported in the literature...The association between cerebellar medulloblastoma and syringomyelia is uncommon and only found in pediatric patients.To date,adult medulloblastoma associated with syringomyelia has not been reported in the literature.Paroxysmal bradycardia is an uncommon clinical manifestation in posterior fossa tumors and likely to be vagally mediated via brainstem preganglionic cardiac motor neurons.This report introduces the diagnosis and treatment of a case of adult medulloblastoma associated with syringomyelia, which presented with paroxysmal bradycardia.展开更多
A simple method of treatment for syringomyelia was investigated in this study. Fourteen patients with syringomyelia were treated by percutaneous lumboperitoneal (LP) shunt. After the surgical shunt, obvious shrinkage ...A simple method of treatment for syringomyelia was investigated in this study. Fourteen patients with syringomyelia were treated by percutaneous lumboperitoneal (LP) shunt. After the surgical shunt, obvious shrinkage of the syrinx was observed in nine patients, no change of the syrinx in two patients, and noticeable postoperative expansion of the syrinx in three patients. The results suggest that cerebrospinal fluid (CSF) moves under intraspinal pressure into the spinal cord, contributing to the formation and maintenance of the syrinx in most of our patients, and that LP shunting can effectively shrink of the syrinx.展开更多
Neuropathic arthropathy (NA) is a progressive, degenerative disorder associated with decreased sensory innervation of the involved joints. The shoulder joint is an uncommon presentation for NA, although syringomyelia ...Neuropathic arthropathy (NA) is a progressive, degenerative disorder associated with decreased sensory innervation of the involved joints. The shoulder joint is an uncommon presentation for NA, although syringomyelia is the most common cause for this joint. Two cases are presented of NA of the shoulder, with both patients having a history of syringomyelia and cocaine use. In both cases a work up for malignancy was negative, but imaging was consistent with NA. Although syringomyelia has been linked with this presentation in prior publications, the role of cocaine use may not be incidental, with complex biochemical interactions in bone metabolism. Cocaine has been shown to involve the Leptin, Neuromedin U (NmU), cocaine and amphetamine-regulated transcript (CART), and Receptor activator of nuclear factor kappa-B ligand (RANKL) pathways of bone remodeling. Treatment can be challenging, involving concurrent use of pharmacotherapy, surgical correction, and protective bracing.展开更多
BACKGROUND Syringomyelia is a disease caused by the formation of a cavity inside the spinal cord and is accompanied by such symptoms as pain,paresthesia,and urination and defecation disorders,and in severe cases cause...BACKGROUND Syringomyelia is a disease caused by the formation of a cavity inside the spinal cord and is accompanied by such symptoms as pain,paresthesia,and urination and defecation disorders,and in severe cases causes various paralyses.Currently,there are only surgical methods for the treatment of syringomyelia,but these methods carry the possibility of failure,recurrence,and side effects.CASE SUMMARY The patient was a 59-year-old woman who suffered from pain due to syringomyelia.For treatment,the patient received transplant of uncultured umbilical cord-derived mesenchymal stem cells.As intended,the patient's pain was relieved after treatment.Interestingly,an additional benefit was found in that the size of the cavity also decreased.After 2 years from the last treatment,the patient's cavity had almost completely disappeared and her syringomyelia was deemed cured.CONCLUSION Using uncultured umbilical cord-derived mesenchymal stem cells may be a new treatment alternative for syringomyelia.展开更多
BACKGROUND Post-arachnoiditis syringomyelia is a condition in which there is an intraspinal cerebrospinal fluid(CSF)blockade due to arachnoidal adhesions and bands.Although many of the techniques currently in use,name...BACKGROUND Post-arachnoiditis syringomyelia is a condition in which there is an intraspinal cerebrospinal fluid(CSF)blockade due to arachnoidal adhesions and bands.Although many of the techniques currently in use,namely,the theco-peritoneal,syringo-pleural,syringo-peritoneal,and syringo-subarachnoid shunts,are effective,the results are often variable.CASE SUMMARY A 36-year-old man with a past history of pulmonary tuberculosis,presented with progressive paraesthesia in the feet and progressive paraparesis along with constipation,difficulty in micturition,and decreased libido.He was bedridden a month before presentation.Magnetic resonance imaging revealed a dorsal multiloculated syrinx from D3-D10 vertebral levels.He underwent a D1-2 to D11 theco-thecal shunt bilaterally to abolish the CSF gradient across the level of the syrinx.There was no direct surgical handling of the spinal cord involved.At the 15-mo follow up,the patient had significant improvement in his symptoms and function.CONCLUSION We present a novel technique aimed at correcting the primary cause of a postarachnoiditis syrinx,the subarachnoid cerebrospinal flow obstruction or block,which we believe is simple and effective,involves minimal handling of the normal neural structures,and attempts to restore the physiology of CSF flow across the obstruction,with favorable clinical results.展开更多
文摘Spinal spondylosis is an extremely common condition that has only rarely been described as a cause of syringomyelia. We describe a case of syringomyelia associated with cervical spondylosis admitted at our division and treated by our institute. It is the case of a 66-yearold woman. At our observation she was affected by moderate-severe spastic tetraparesis. T2-weighted magnetic resonance imaging(MRI) showed an hyperintense signal within spinal cord from C3 to T1 with a more sharply defined process in the inferior cervical spinal cord. At the same level bulging discs, facets and ligamenta flava hypertrophy determined a compression towards subarachnoid space and spinal cord. Spinal cord compression was more evident in hyperextension rather than flexion. A 4-level laminectomy and subsequent posterior stabilization with intra-articular screws was executed. At 3-mo follow up there was a regression of tetraparesis but motor deficits of the lower limbs residuated. At the same follow up postoperative MRI was executed. It suggested enlargement of the syrinx. Perhaps hyperintensity within spinal cord appeared "bounded" from C3 to C7 with clearer margins. At the level of surgical decompression, subarachnoid space and spinal cord enlargement were also evident. A review of the literature was executed using Pub Med database. The objective of the research was to find an etiopathological theory able to relate syringomyelia with cervical spondylosis. Only 6 articles have been found. At the origin of syringomyelia the mechanisms of compression and instability are proposed. Perhaps other studies assert the importance of subarachnoid space regard cerebrospinal fluid(CSF) dynamic. We postulate that cervical spine instability may be the cause of multiple microtrauma towards spinal cord and consequently may damage spinal cord parenchyma generating myelomalacia and consequently syrinx. Otherwise the hemorrhage within spinal cord central canal can cause an obstruction of CSF outflow, finally generating the syrinx. On the other hand in cervical spondylosis the stenotic elements can affect subarachnoid space. These elements rubbing towards spinal cord during movements of the neck can generate arachnoiditis, subarachnoid hemorrhages and arachnoid adhesions. Analyzing the literature these "complications" of cervical spondylosis are described at the origin of syringomyelia. So surgical decompression, enlarging medullary canal prevents rubbings and contacts between the bone-ligament structures of the spine towards spinal cord and subarachnoid space therefore syringomyelia. Perhaps stabilization is also necessary to prevent instability of the cervical spine at the base of central cord syndrome or syringomyelia. Finally although patients affected by central cord syndrome are usually managed conservatively we advocate, also for them, surgical treatment in cases affected by advanced state of the symptoms and MRI.
文摘Neuropathic arthropathy of the shoulder is a rare disorder characterized by joint degeneration, and is associated with loss of sensory innervation. Syringomyelia is a disease in which fluid-containing cavities(syrinxes) form within the spinal cord. Here, we report a case of neuropathic arthropathy of the shoulder secondary to syringomyelia in a 40-year-old woman. X-rays of the left shoulder revealed damage to bone and joint architecture. Blood tests indicated vitamin D deficiency and secondary hyperparathyroidism. Magnetic resonance imaging of the cervical spine showed a large syrinx from the second cervical spine to the second dorsal spine. Although neuropathic arthropathy is uncommon, it should be considered in cases of unexplained pain, discomfort, or limited range of motion of the affected joint. Symptoms related to the affected joint may precede or overshadow neurological deficits. Appropriate radiological examinations and diagnoses are imperative to prevent misdiagnosis or undetected bone and joint disorders.
文摘BACKGROUND Charcot neuroarthropathy(CN)is a systemic disease characterized by progressive bone loss and destruction,which is usually closely related to diabetes,HIV,etc.However,CN caused by syringomyelia accounts for only 5%of CN cases;the shoulder and elbow are most often involved,and the hip joint is rarely affected.As a rare factor,cervical spondylotic myelopathy(CSM)can be associated with syringomyelia,which is scarcely reported in the literature.Here,we present the first case report to date of CN of the hip caused by syringomyelia secondary to CSM.CASE SUMMARY We describe a 76-year-old male patient who was diagnosed with CSM due to neck pain and weakness of limbs 16 years ago.Four years ago,he noticed recurrent swelling of the right hip with pain and was diagnosed with degenerative arthritis.Recently,however,his symptoms gradually worsened,and because of progressive pain,destabilization and weakness of the right hip,he was admitted to our hospital.Through systematic physical,radiographic and laboratory examinations,we finally reached a diagnosis:CN of the right hip associated with syringomyelia secondary to CSM.After comprehensive evaluation of the patient's condition,we performed right total hip arthroplasty.During the follow-up,the patient felt well clinically and could walk independently with a knee brace.CONCLUSION We suggest a possible etiological association between CSM and syringomyelia,which may reflect a potential pathogenesis of CN.We encourage clinicians to actively carry out a detailed medical history and comprehensive physical and imaging examinations in patients with joint lesions,especially chronic shoulder neck pain,to rule out the possibility of this association,which plays a crucial role in the early diagnosis of CN.Arthroplasty may no longer be an absolute contraindication to surgical treatment of CN.Reasonable selection of the surgical strategy can markedly improve the clinical symptoms and quality of life of patients.
基金the National Natural Science Foundation of China (30300359)
文摘Objective： To describe the MRI findings and discuss the pathogenesis formation mechanism of syringomyelia in the patients after spine surgical operation. Methods： Totally 13 patients were been enrolled in the study. Before operation, none of our patients presented with spinal cord syringomyelia. The mean follow-up duration was 6 years （range 2-10 months） by MRI. Four of the 13 patients after spinal cord tumor removed operation, 3 patients after spinal trauma operation, 2 cases had scoliosis before, 2 cases were cervical spondylotic myelopathy and 2 cases had tethered cord syndrome before operation. MR features of pre- and post-operation on all patients were been studied in contrast with surgical results and clinical symptoms. The radiology diagnostic was made by 3 different radiologists respectively. The characteristics of length, width, signals, shape of cavity and spinal cord position as well as subarachnoid shape were focused on. Results： All the patients had no syringomyelia on MRI before operation. The spinal cord of 7 patients showed persist compression and 2 patients had tethered cord before operation. MRI features of syringomyelia after operation in our cases showed longitudinal cavity with syrinx fluid had T1 and T2 relation characteristics of cerebrospinal fluid （CSF）. The mean length was 5.5 spinal segment, 4 cord of 13 patients presented cord compressed from anterior materials, 4 occurred postoperative adhesion to the back of lumbar spinal canal and spinal cord of 1 cases clung to the front wall of cervical spinal canal. Conclusion： The mechanism of syringomyelia in the patients after spinal surgical intervention may be the persisting compression or intention of the spinal cord in the period of pre- or post-operation. The edema, cyst, malacia of spinal cord are the most important lesions and risk factors resulted in the syringomyelia.
文摘The association between cerebellar medulloblastoma and syringomyelia is uncommon and only found in pediatric patients.To date,adult medulloblastoma associated with syringomyelia has not been reported in the literature.Paroxysmal bradycardia is an uncommon clinical manifestation in posterior fossa tumors and likely to be vagally mediated via brainstem preganglionic cardiac motor neurons.This report introduces the diagnosis and treatment of a case of adult medulloblastoma associated with syringomyelia, which presented with paroxysmal bradycardia.
文摘A simple method of treatment for syringomyelia was investigated in this study. Fourteen patients with syringomyelia were treated by percutaneous lumboperitoneal (LP) shunt. After the surgical shunt, obvious shrinkage of the syrinx was observed in nine patients, no change of the syrinx in two patients, and noticeable postoperative expansion of the syrinx in three patients. The results suggest that cerebrospinal fluid (CSF) moves under intraspinal pressure into the spinal cord, contributing to the formation and maintenance of the syrinx in most of our patients, and that LP shunting can effectively shrink of the syrinx.
文摘Neuropathic arthropathy (NA) is a progressive, degenerative disorder associated with decreased sensory innervation of the involved joints. The shoulder joint is an uncommon presentation for NA, although syringomyelia is the most common cause for this joint. Two cases are presented of NA of the shoulder, with both patients having a history of syringomyelia and cocaine use. In both cases a work up for malignancy was negative, but imaging was consistent with NA. Although syringomyelia has been linked with this presentation in prior publications, the role of cocaine use may not be incidental, with complex biochemical interactions in bone metabolism. Cocaine has been shown to involve the Leptin, Neuromedin U (NmU), cocaine and amphetamine-regulated transcript (CART), and Receptor activator of nuclear factor kappa-B ligand (RANKL) pathways of bone remodeling. Treatment can be challenging, involving concurrent use of pharmacotherapy, surgical correction, and protective bracing.
文摘BACKGROUND Syringomyelia is a disease caused by the formation of a cavity inside the spinal cord and is accompanied by such symptoms as pain,paresthesia,and urination and defecation disorders,and in severe cases causes various paralyses.Currently,there are only surgical methods for the treatment of syringomyelia,but these methods carry the possibility of failure,recurrence,and side effects.CASE SUMMARY The patient was a 59-year-old woman who suffered from pain due to syringomyelia.For treatment,the patient received transplant of uncultured umbilical cord-derived mesenchymal stem cells.As intended,the patient's pain was relieved after treatment.Interestingly,an additional benefit was found in that the size of the cavity also decreased.After 2 years from the last treatment,the patient's cavity had almost completely disappeared and her syringomyelia was deemed cured.CONCLUSION Using uncultured umbilical cord-derived mesenchymal stem cells may be a new treatment alternative for syringomyelia.
文摘BACKGROUND Post-arachnoiditis syringomyelia is a condition in which there is an intraspinal cerebrospinal fluid(CSF)blockade due to arachnoidal adhesions and bands.Although many of the techniques currently in use,namely,the theco-peritoneal,syringo-pleural,syringo-peritoneal,and syringo-subarachnoid shunts,are effective,the results are often variable.CASE SUMMARY A 36-year-old man with a past history of pulmonary tuberculosis,presented with progressive paraesthesia in the feet and progressive paraparesis along with constipation,difficulty in micturition,and decreased libido.He was bedridden a month before presentation.Magnetic resonance imaging revealed a dorsal multiloculated syrinx from D3-D10 vertebral levels.He underwent a D1-2 to D11 theco-thecal shunt bilaterally to abolish the CSF gradient across the level of the syrinx.There was no direct surgical handling of the spinal cord involved.At the 15-mo follow up,the patient had significant improvement in his symptoms and function.CONCLUSION We present a novel technique aimed at correcting the primary cause of a postarachnoiditis syrinx,the subarachnoid cerebrospinal flow obstruction or block,which we believe is simple and effective,involves minimal handling of the normal neural structures,and attempts to restore the physiology of CSF flow across the obstruction,with favorable clinical results.
