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 .
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
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 until some symptoms are present“ or shall I simply forget about this syrinx ? Are there any medicines to dissolve the cyst or surgery is the only alternative to eradicate it? kindly advise .I enclose herewith the enlarged pic s of my MRI .
My email is : firstname.lastname@example.org
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