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Thread: Myelomalacia,syrinx, newly diagnosed

  1. #1
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    Myelomalacia,syrinx, newly diagnosed

    I just received the results of an MRI of my C spine, ordered because of a long history of migraines, headaches, and neck and back pain. (I am a 49 yr. old WF in menopause)
    The impressions was listed in this way: SMALL CENTRAL EITHER DISC CALCIFICATION OR OSTEOPHYTE FORMATION AT C4-C5 CAUSING MILD SPINAL STENOSIS
    INCREASED SIGNAL INTENSITY ON THE SPINAL CORD AT C4-C5 WITH EXTENSION SUPERIOR TO C3 AND INFERIOR TO C7. THIS FINDING IS HIGHLY CONSIDERED MYELOMALACIA WITH SYRINX. NARROWED NEURAL FORAMEN AT C4-C5 ON THE LEFT SECONDARY TO EITHER A CALCIFIED DISC OR OSTEOPHYTE FORMATION.
    Please help me to understand what this means. I have had lots of problems with my hands and arms lately-numbing, pain, tingling, shock sensations, dropping things, knocking things over; fairly severe pain in my hips, low back, my left knee giving out on me, right knee locking, loss of balance; urinary incontinence; severe fatigue, weakness; recent bloodwork revealed low TSH, additional thyroid bloodwork just ordered. The only accidents I have ever had were two minor rear end collisions with whiplash injury, many years ago, and a very hard fall at work about 8 months ago when my heel caught on a piece of pavement, the brunt of my weight was to my hands.
    Thanks so much, and can you also let me know how to access the myelomalacia articles? I have tried several times unsuccessfully. Mary Ellen
    I've been treating with a neurologist for the migraines at the Univ. of Penn. and am scheduled to see him in a couple of weeks. The C spine MRI films have been sent to him, however, I am very anxious to learn as much as I can about the findings noted. The most recent MRI done of my brain showed what looked to be very old brain injury, (he likened it to evidence of acute carbon monoxide poisoning).

  2. #2
    Labruto (Mary Ellen),

    Let me comment briefly.

    1. SMALL CENTRAL EITHER DISC CALCIFICATION OR OSTEOPHYTE FORMATION AT C4-C5 CAUSING MILD SPINAL STENOSIS
    • This indicates presence of increased calcium in tissue at the C4-5 spine level that is narrowing the canal through which the spinal cord courses. Note that this does not indicate that the spinal cord is being compressed, only that the canal is narrowed. Spinal stenosis means narrowing of the spinal canal. The report suggests that the increased calcification may be either an osteophyte (increased bone growth) or a calcified disc (spinal disc) and is located in the middle (central).

    2. INCREASED SIGNAL INTENSITY ON THE SPINAL CORD AT C4-C5 WITH EXTENSION SUPERIOR TO C3 AND INFERIOR TO C7
    • On magnetic resonance images (MRI), the presence of injury to the spinal cord often manifests as increased signal intensity. Note that that this usually implies the presence of recent or continuing injury because increased signal intensity suggests edema or increased water content in the spinal cord. This increase in signal intensity appears to be maximal at C4-5 and extends to above C3 and below C7, suggesting that quite a bit of the spinal cord is involved.

    3. NARROWED NEURAL FORAMEN AT C4-C5 ON THE LEFT.
    • The neural foramen, I believe, is referring to the opening in the spinal column through which the nerve roots pass. This statement suggests that there is narrowing of the C4-C5 left neural foramen.

    4. MYELOMALACIA WITH SYRINX.
    • Myelomalacia suggests that there has been loss of white matter (the part of the spinal cord that has myelinated axons). This is common in people with spinal cord injury. Syrinx refers to the presence of a cyst in the spinal cord. Such cysts contain cerebrospinal fluid and often form after spinal cord injury, due to scar tissue adhesions between the spinal cord and the surround arachnoid and dural membranes, preventing flow of cerebrospinal fluid.

    5. "recent MRI done of my brain showed what looked to be very old brain injury, (he likened it to evidence of acute carbon monoxide poisoning)."
    • It is hard to judge from your description what exactly is happening. The fact that the neurologist likened this to acute carbon monoxide poisoning suggests that he does not see localized changes in the brain but overall changes suggesting of brain damage.

    On the basis of your posting, the clarity of your comments, and the history that you have given, I think that you have evidence of injury to your spinal cord localized to C4-5, probably related to a previous trauma. There is evidence of spinal cord damage with a syringomyelic cyst that suggest the formation of adhesive scarring that extends from C3 to C8. You probably have some osteoarthritis at C4/5 that seems to be affecting the left spinal root. This would be consistent with some of your symptoms, including the fatigue, loss of balance, urinary incontinence, weakness. I don't know what to make of the suggested brain changes, whether these are related to your migraine or to other factors.

    Assuming that you have not yet had this evaluated by a neurosurgeon, I would urge you to get a neurosurgical opinion of the neck. Surgical decompression of the C4/5 spinal root may help relieve some of the symptoms on the left arm but may not have much effect on long-standing pain. Decompression of the spinal cord may help relieve some of the pain and symptoms that you report below the injury site. While the description that you give does not rule out the possibility of other conditions such as multiple sclerosis, lupus erythematosus, or previous brain injury, I think that these diagnoses are further down the list of suspects.

    Wise.

    [This message was edited by Wise Young on Oct 21, 2002 at 12:39 PM.]

  3. #3
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    Myelomalacia, etc.

    Dear Dr. Young,
    I can not begin to tell you how grateful I am for your quick and comprehensive reply. As you can imagine, I was alternately, numb, confused, feeling sorry for myself, and angry, and quite desperate for additional information. I'm the type of person who needs to get my arms around something like this, and understand what I'm dealing with. The anger actually helped to energize me for dealing with one of the pointy-headed little bureaucrats at my office where I have devoted nearly 26 years of my life, giving it 110%. While I've been managing what has been described as one of, if not the best, court volunteer programs in the country, and with no help for over a year now, I do two full-time assignments, and it isn't simply administrative, but also involves sitting for long periods of time doing heavy computer work, and a considerable amount of heavy lifting in setting up training programs. I expect my neurologist to receive the actual films today, and one of his subspecialties is neuro-imaging. With your answers about what the findings mean, it will help me to put one foot in front of the other to see what the ultimate answers are, and what I need to do to deal with the outcome.
    Bless you, and sincere thanks,
    Mary Ellen LaBruto

  4. #4
    I too, Was recently diagnosed with Myelomalacia. I don't know a whole lot about it. Except what I've read on here. In 2006 I was in a auto accident in which I injured my shoulder and neck. The doc sent me to get MRI and x-rays. He stated that I had damaged my rotator cup in my shoulder and had sprained my neck(Whiplash) After a couple months and a lot of therapy. I was feeling better not healed but better. In 2007 I was hit from behind by another driver doing 40-50 mph While my car was sitting at a stand still. I hit my head and was knocked out. When I was treated at the ER. I hand pain everywhere but mostly in shoulder,neck,l hand,r knee. Went back to the doc. And went through the same thing as before but this time the doc sent me to a neurologist to look at my neck. Because I was feeling different (more intense) tingling in my hands. I had to pick up
    The MRI films. To take them to the neurologist. At that time I read the report. It was as follows:

    Technique: sagital and axial sequences
    Findings: reversal of normal cervical curvature appex at C5-6 No fracture or dislocation. No cranial cervical junction mass noted.
    C4-5 Mild anterior dural sac compression by posterior annulus/spur. No change.
    C5-6 Anterior dural sac compression by posterior annulus/spur. Left uncinate process spur. The cord is focally atrophic although it is not currently compressed. In addition ,there is linear myelomalacia in both the right and left central cord extending from approximately the mid C5 to C vertebral body levels,slightly longer on the left than on the right. No significant change.
    C-7 Anterior dural sac compression by posterior annulus/spur,Right greater than left. no change.

    When I see no change that makes me think it was there in 2006. So I check and there it is. Shouldn't this have been obvious to the doctor. The first time. I had complained about it but he wanted to concentrate on the shoulder. And attributed to neck sprain. Am I in serious trouble with this. Every thing I've read is pretty grim. I have pain in both arms,Weak through out my body. Extreme headaches, pain in legs and feet. Some times it feels like my socks are roled up under my feet. Like there half on.
    Is this a desease or from injury? Or injury that causes desease? Can it be cured or treated? What is usually the prognosis. Can this parylize me? I went to neuro surgeon they say they don't think it needs surgery. The nerologist had me on Gabapentin All it did was make me extremely drowsy and gave me bad dreams and thoughts. When I told him I couldn't take it anymore. He dropped me like a hot rock. I'm scared and confused. And desperate for some clear answers. My friend wants to send me up to the cleveland clinic but if they can't cure it or treat it without drugging me up
    to the point I can't function normally. Whats the point? Can anyone help?

  5. #5
    Quote Originally Posted by stainlesslobster
    I too, Was recently diagnosed with Myelomalacia. I don't know a whole lot about it. Except what I've read on here. In 2006 I was in a auto accident in which I injured my shoulder and neck. The doc sent me to get MRI and x-rays. He stated that I had damaged my rotator cup in my shoulder and had sprained my neck(Whiplash) After a couple months and a lot of therapy. I was feeling better not healed but better. In 2007 I was hit from behind by another driver doing 40-50 mph While my car was sitting at a stand still. I hit my head and was knocked out. When I was treated at the ER. I hand pain everywhere but mostly in shoulder,neck,l hand,r knee. Went back to the doc. And went through the same thing as before but this time the doc sent me to a neurologist to look at my neck. Because I was feeling different (more intense) tingling in my hands. I had to pick up
    The MRI films. To take them to the neurologist. At that time I read the report. It was as follows:

    Technique: sagital and axial sequences
    Findings: reversal of normal cervical curvature appex at C5-6 No fracture or dislocation. No cranial cervical junction mass noted.
    C4-5 Mild anterior dural sac compression by posterior annulus/spur. No change.
    C5-6 Anterior dural sac compression by posterior annulus/spur. Left uncinate process spur. The cord is focally atrophic although it is not currently compressed. In addition ,there is linear myelomalacia in both the right and left central cord extending from approximately the mid C5 to C vertebral body levels,slightly longer on the left than on the right. No significant change.
    C-7 Anterior dural sac compression by posterior annulus/spur,Right greater than left. no change.

    When I see no change that makes me think it was there in 2006. So I check and there it is. Shouldn't this have been obvious to the doctor. The first time. I had complained about it but he wanted to concentrate on the shoulder. And attributed to neck sprain. Am I in serious trouble with this. Every thing I've read is pretty grim. I have pain in both arms,Weak through out my body. Extreme headaches, pain in legs and feet. Some times it feels like my socks are roled up under my feet. Like there half on.
    Is this a desease or from injury? Or injury that causes desease? Can it be cured or treated? What is usually the prognosis. Can this parylize me? I went to neuro surgeon they say they don't think it needs surgery. The nerologist had me on Gabapentin All it did was make me extremely drowsy and gave me bad dreams and thoughts. When I told him I couldn't take it anymore. He dropped me like a hot rock. I'm scared and confused. And desperate for some clear answers. My friend wants to send me up to the cleveland clinic but if they can't cure it or treat it without drugging me up
    to the point I can't function normally. Whats the point? Can anyone help?
    Stainless lobster, what you have is very common and not easily treatable. Based on your description, you have had two accidents that have caused whiplash. The MRI suggest that you have disc herniations that are pressing on the front part of the spinal dural sac at C4/5, C5/6, and C7. These apparently are not pressing of the spinal cord itself but you have some atrophy of the spinal cord at C5/6, consistent with the history of whiplash.

    At the present, it is not clear whether surgery will do much to help. If you have disc compression on your nerve roots on one side with definite neurological symptoms from that compression, I would recommend surgery but it doesn't seem to be the case. If you have compression of the spinal cord, I would also recommend surgery, but the MRI suggests this is not so.

    Atrophy of the spinal cord is not dangerous. It is to be expected, especially since you have had at least two episodes of whiplash. I would recommend physical therapy and avoidance of further stress of your neck. I hope that it gets better.

    Wise.

  6. #6

    Central myelomalacia / early syrinx formation

    Dear Dr. Young,

    I am 37 years old. For more than 10 years now I have been experiencing numbness off & in my right thigh. Recently however, I intermittently feel numbness in my upper arms, both right and left, radiating downwards from the shoulders.

    About a year ago I saw a neurologist who diagnosed neuralgia. He prescribed amongst other drugs Tegretol, Omega 3 fatty acid etc. The drugs only delivered temporary relief and I always ended up performing below my optimum daily, feeling half awake and dull. I had to stop the drugs after using them religiously for about 4 months.

    Recently, I feel worse. The numbing pains are more regular. I was scheduled for MRI Test. The results showed the following:

    1. loss of cervical lordosis.
    2. Vertebral heights are normal.
    3. Linear T1 hypo and T2 hyper intensity noted in the cervical cord at C6 and C7 vertebral levels.
    4. On contrast administration there is no enhancement.
    5. Small central disc bulge noted at C5-C6 and C6-C7 levels indenting
    anterior subarchnoid space.
    6. Spinal canal is adequate.
    7. Atlanto axial joint is normal.
    8. No evidence of intrathecal SOL.
    9. Pre and para spinal soft tissues are normal.
    IMPRESSION:
    FEATURES OF ENHANCING T1W AND T2W HYPER INTENSITY IN THE CERVICAL CORD AT C6 AND C7 VERTEBRAL LEVEL IN KEEPING WITH CENTRAL MYELOMALACIA / EARLY SYRINX FORMATION.
    CORRELATE CLINICALLY AND FOLLOW UP.

    Dr. Young, Can you please interpret the above for me? I remember I had a severe household accident on my lower spine in the bathroom around 2002. Could all these pains be connected to this? The orthopedic surgeon that I saw directed me again to a neurologist. In the country that I stay, neurologists are hard to come by and quite expensive too! Please help.

    What really is my prognosis? Any advice on the drugs I can use?

    Bless you.

    Babsjay

  7. #7
    Dear Dr. Young,

    I am 37 years old. For more than 10 years now I have been experiencing numbness off & in my right thigh. Recently however, I intermittently feel numbness in my upper arms, both right and left, radiating downwards from the shoulders.

    About a year ago I saw a neurologist who diagnosed neuralgia. He prescribed amongst other drugs Tegretol, Omega 3 fatty acid etc.

    The drugs only delivered temporary relief and I always ended up performing below my optimum daily, feeling half awake and dull. I had to stop the drugs after using them religiously for about 4 months.

    Recently, I feel worse. The numbing pains are more regular. I was scheduled for MRI Test. The results showed the following:

    1. loss of cervical lordosis.
    2. Vertebral heights are normal.
    3. Linear T1 hypo and T2 hyper intensity noted in the cervical cord at C6 and C7 vertebral levels.
    4. On contrast administration there is no enhancement.
    5. Small central disc bulge noted at C5-C6 and C6-C7 levels indenting
    anterior subarchnoid space.
    6. Spinal canal is adequate.
    7. Atlanto axial joint is normal.
    8. No evidence of intrathecal SOL.
    9. Pre and para spinal soft tissues are normal.

    IMPRESSION:
    FEATURES OF ENHANCING T1W AND T2W HYPER INTENSITY IN THE CERVICAL CORD AT C6 AND C7 VERTEBRAL LEVEL IN KEEPING WITH CENTRAL MYELOMALACIA / EARLY SYRINX FORMATION.
    CORRELATE CLINICALLY AND FOLLOW UP.

    Dr. Young, Can you please interpret the above for me? I remember I had a severe household accident on my lower spine in the bathroom around 2002. Could all these pains be connected to this?

    The orthopedic surgeon that I saw directed me again to a neurologist. In the country that I stay, neurologists are hard to come by and quite expensive too! Please help.

    What really is my prognosis? Any advice on the drugs I can use?

    Bless you.

    Babsjay

  8. #8
    Babjay,

    I see nothing in the MRI report that suggest any cause that would benefit from surgery or any other intervention. The signal changes described in the C6/7 spinal cord are non-specific. The discs indenting the subarachnoid space should be watched but at the present time they do not seem to be compressing the spinal cord.

    Can you describe the "numbing pains" that led to the diagnosis of "neuralgia". Is it aching, sore, sharp, pressure, burning? Is it most prevalent during the day or night. If there anything or position that you can put yourself in to minimize the pain. Does movement aggravate the pain?

    Wise.

  9. #9
    Senior Member alan's Avatar
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    I'm C-5. I've had worsening pains everywhere below injury level since they began in 1981, I've some lost sensation in the top of my back (replaced by pain, naturally), lost some arm function, but every neurosurgeon over the years I've seen or who has seen my MRIs, save one, says there's no tethering or syrinx, just a hole where the damaged spinal cord was. I've had MRIs since 1985 (that one was before my fusion wires were removed), and the reports have always been the same - no change from previous scan. There is a hole between C-3 and C-7, myelomalacia, degenerating disks above and below the C-4 to C-6 fusion, the laminectomy of C-5 done in 1987 to hunt for a syrinx (none found), reverse cervical lordosis.

    The neurosurgeon who sees a syrinx doesn't give a high probability of surgery improving matters, or stopping the problems from getting worse (he also doesn't see change between MRIs years apart.) Other recent opinions all think the problem is aging with SCI. Nobody ever wanted to surgically deal with my curves, either.
    Alan

    Proofread carefully to see if you any words out.

  10. #10

    Diagnosis of neuralgia, central myelomalacia & early syrinx formation

    Dear Dr. Young,

    Thank you for your response to my earlier cry for help.

    The numbing pains I described initially which led the neurologist to diagnose neuralgia goes off and on daily.
    It can be described as a sore/burning pains, prevalent towards evenings. I usually experience problems going to sleep at night because of the pains in the legs and arms.

    I notice that if I stay in any particular position/posture for long, it aggravates/jumpstarts the pains afresh.
    Movement tends to relieve the pains.

    What do you think?

    Thank you.

    Babsjay.
    Quote Originally Posted by Wise Young View Post
    Babjay,

    I see nothing in the MRI report that suggest any cause that would benefit from surgery or any other intervention. The signal changes described in the C6/7 spinal cord are non-specific. The discs indenting the subarachnoid space should be watched but at the present time they do not seem to be compressing the spinal cord.

    Can you describe the "numbing pains" that led to the diagnosis of "neuralgia". Is it aching, sore, sharp, pressure, burning? Is it most prevalent during the day or night. If there anything or position that you can put yourself in to minimize the pain. Does movement aggravate the pain?

    Wise.

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