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Thread: by chance knowing about a small syrinx

  1. #1

    by chance knowing about a small syrinx

    I am 70 year old man from India .I am hereunder giving the past and present case history

    Past History

    I had IHD in the year 1977 (T wave inversion in V1 to V6) No complications since then
    Had mild Hypertension in the year 1980 (under control)
    Had prediabetes in the year 2010 (IFG) (under control)
    Had subclinical hypothyroidsm in 2011

    Medicines now being used
    Heart * (from the year 1977)

    STAMLO BETA 50 MG 1 Tab a day ( Initally Inderal( 77-81), then
    Aten 50 and stamlo 5 mg (81-2006) and hen Stamlobeta 50 mg (2006 to date)

    ISMO 10 MG One tab Twice a day since 1996

    Tg Tor 5 MG One tab Once a day after dinner since 1996

    ASA 50 MG One tab a day after dinner since 1991

    Type II diabets

    GLYCOMET 250 MG 1/2 Tab twice a day since oct2010

    Sub clinical Hypothyroidism

    THYRONORM 50 MCG One tab once a day since july 2011 1

    present case

    Recently one and half months back in December 2011 while I was getting up from the bed in the early morning , I have unmindfully, stretched my hands and legs to ward off my lethargy , eventually, I think I shrunk my head into my neck region on the pillow. I heard some sort of clip like sound in my head at that time. After I got up from the bed, I had reeling sensation. So I approached the Ortho who said that it is postural vertigo because of a middle ear problem and also because of cervical spondylosys he has suggested Stugeron 50 mg twice a day and Vertin 16 ng once a day for a period of 4 weeks and advised me to take an MRI for cervical spine, since I have cervical spondylosys since many years . Accordingly I have undergone MRI.

    The Impression is: a)Early changes of cervical spondyilosis with multiple level changes of degenerative discs, marginal osteophytosis and mild disc bulge is seen at C3/4, C4/5,C5/6,C6/7 discs. No obvious thecal sac indentation/neural foraminal encroachment seen at any level

    Cervical lordosis is maintained.

    Vertebral bodies appears normal in contour , body heights, alignment and signal intensity.

    Marginal osteophytes are seen anteriorly and posteriorly from c2 to c6 levels.

    No obvious spondylolistthesis seen

    All cervical intervertebral discs are dark on T2WI with decreased disc heights-suggestive of changes of disc dessication

    Contour of c2/3 adisc is normal

    Mild flateening of contour with slight posterocentral disc bulge is seen at c3/4, c4/5,c5/6 ,c6/7 discs. No obvious thecal sac indentation/neural formainal encroachment seen at any level.

    Early facetal arthropathy changes seen at all levels.

    Anterior longitudinal and posterior longitudinal ligaments are normal.

    Ligamentum flavum is normal

    Cranio-vertebral junction is normalT1 hypootense, T1 STIR hypotense well defined vertically oriented lesionof size 3.2x3.3.x11.1 mm (APxTRxCC) is seen centrally within the cord substances at C4/5 , c5 levels

    Pre and paravertebral soft tissues appear normal

    B]A small Syrinx within the cord at c4/5 and c5 level.

    The ortho refered me to a neuro who in turn suggested the same medicine which was prescribed by my ortho. Regarding syrinx, he said that this may be a cyst since tumor in that region at this age of 70 is very rare. Even if it is cyst, it will grow over a period of time and some times people may not know about the presence of the cyst in their body and will pass off their life. As the present cyst is asymptomatic,do you suggest me to wait and see for some time and go for a contrast MRI after 6 months to see whether it is growing or not.. Though Surgery is the only alternative, is it not very risky to perform at this age and with so many ailments and also it involved spine? I have never experienced headache at any time .but I used to feel burning sensation in my forehands even in the year 1996 and stabbing pain between the shoulders on the back leftside and burning sensation in the ribs in 1980 between 1996 and 2000. I have fallen many a time from the scooter.In 1996, I have fallen like a bunch of books on the ground . After that I have never experienced any fall. Kindly give your opinion . Personally I feel that I should not undergo surgery at this age with so many ailments What is your opinion? Are there any medicines to dissolve the cys?t.If so kindly prescribe me with dosage. At present or in the recent past since 10 years i have never experienced any symptoms. I never had any headache or whatsoever at any time . I am in a dialemma whether to go for surgery or not. Please advise me.

  2. #2
    Of course we cannot make a diagnosis over the internet, and as always, before considering elective surgery, a second or even third opinion is strongly encouraged. I have asked Dr. Young to comment when he has time.

    (KLD)

  3. #3
    Quote Originally Posted by SCI-Nurse View Post
    Of course we cannot make a diagnosis over the internet, and as always, before considering elective surgery, a second or even third opinion is strongly encouraged. I have asked Dr. Young to comment when he has time.

    (KLD)
    vedanth1942,

    I am not convinced that the syrinx is causing some or most of your symptoms. You have many reasons for those symptoms. There is no reason for operation or any treatment of a small asymptomatic syringomyelic cyst.

    Wise.

  4. #4
    Dear Doctor,
    I thank you very much for your kind reply. Do you suggest me to postpone my contrast MRI until unless i have related symptoms. I am told that severe headache is the most specific symptom for a growing syrinx. Shall I continue playing the Billiard and snooker game which i love so much and is my past time. Can I continue with my 4 km morning walk regularly? kindly advise Doctor.

  5. #5

    Unhappy By chance seen a small syrinx at c4/c5 level in cervical spine mri

    Dear Doctor Huang

    Good morning sir.
    I furnish hereunder the detailed case history of mine . I request your good selves to kindly go through this patiently and advise me by email or through this coloumn and I am sorry I must be taking your valuable time. Please excuse me. I am very much worried and scared in this regard.

    Dear Doctor, I am a 69 year old male .
    This was happened. While I was in the bed two months back, before I get up to go for my usual morning walk, I have stretched my hands and legs stiffly to ward off the lethargy. In that process, I felt that I have drawn my head in to the neck when I stretched my hands and legs. I felt a small clip like sound in the vertebrae. After I got up from the bed, I had reeling sensation. So I have approached the Orthopaedician for taking some drug . He said it is due to postural vertigo because of a probable middle ear problem and also may be due to cervical spondylosis and suggested Stugeron 50 mg twice a day and Vertin 16 mg once a day. He suggested MRI for cervical spine since I have cervical spondylosys since many years from 1995 onwards to know the present state of vertebrae
    Accordingly I went for an MRI on 24th December 2011 of the cervical spine .
    RADIOLOGIST IMPRESSION

    a)Early changes of cervical spondilosys with multiple level changes of degenerative discs, marginal osteophytosis and mild disc bulge is seen at C3/4, C4/5,C5/6,C6/7 discs. No obvious thecal sac indentation/neural foraminal encroachment seen at any level

    Cervical lordosis is maintained.

    Vertebral bodies appears normal in contour , body heights, alignment and signal intensity.

    Marginal osteophytes are seen anteriorly and posteriorly from c2 to c6 levels.

    No obvious spondylolistthesis seen

    All cervical intervertebral discs are dark on T2WI with decreased disc heights-suggestive of changes of disc dessication

    Contour of c2/3 adisc is normal

    Mild flateening of contour with slight posterocentral disc bulge is seen at c3/4, c4/5,c5/6 ,c6/7 discs. No obvious thecal sac indentation/neural formainal encroachment seen at any level.

    Early facetal arthropathy changes seen at all levels.

    Anterior longitudinal and posterior longitudinal ligaments are normal.

    Ligamentum flavum is normal

    Cranio-vertebral junction is normalT1 hypootense, T1 STIR hypotense well defined vertically oriented lesionof size 3.2x3.3.x11.1 mm (APxTRxCC) is seen centrally within the cord substances at C4/5 , c5 levels

    Pre and paravertebral soft tissues appear normal

    B] A small Syrinx within the cord at c4/5 and c5 level in the size of a small rice grain.

    The Ortho refered to a neuro surgeon . He said that the present condition is postural vertigo and asked me to continue the medicine which was prescribed by my ortho. The Neuro said that the syrinx may be a cyst or a tumor and asked me to undergo contrast MRI in the month of june since it is asymptomatic right now . Remember , by chance only I have come to know about the presense of a syrinx in the cervical spine. If I did not undergo MRI, we would not have come to know of it.
    I have asked another neurologist and I am told , that presense of tumor at this age in that region is very rare and most probably the syrinx is a small cyst due to cervical spondilosys. Also he told me that many people even do not know about the presense of the syrinx in their body and will pass off their life. The syrinx will take a lot of time to grow along the spinal cord and damage it. Generally the syrinx may form either at the birth (congenital) or may be due to a fall and had a injury to the spine. I have fallen many a time from the two wheler till the year 1995. Once in the year 1996, I fell flat like a bunch of books from a height of two feet with my back completely touched the floor However the head did not touched the floor . i do not know whether this has any bearing on this syrinx or not. I have never had any symptoms during all these 15 years or even now. My medicinal history is as under

    MEDICAL INFORMATION

    I had IHD in the year 1977 (T wave inversion in V1 to V6) No complications since then
    Had mild Hypertension in the year 1980 (under control)
    Had prediabetes in the year 2010 (IFG) (under control)
    Had subclinical hypothyroidsm in 2011


    Since I am in advanced age, and I have some other old age ailments like IHD (1977), Diabetes (2010),Hypertension (1980), Hypothyroidsm ( june2011) what is your valuable suggestion in this context since the presence of a cyst is asymptomatic in my case and came to know of it accidentally. Do I have to really undergo a contrast MRI or not, or shall I follow “wait and see approach “ or shall I simply forget about that ? Are there any medicines to dissolve the cyst?

    My email is : vedanth1942@yahoo.com
    Last edited by vedanth1942; 03-01-2012 at 04:21 AM.

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