How a cavity is formed
The spinal cord is bathed in cerebrospinal fluid, which circulates freely around it and in the central canal. If an obstruction occurs at the level of the transition from the head to the neck or in the spinal canal itself, the normal flow of fluid is disrupted and it begins to accumulate inside the substance of the spinal cord. This forms a cavity, which can lengthen and expand over time. The location of the cavity explains the symptoms: first of all, the fibers that cross in the center and carry information about pain and temperature are damaged.
- Poor circulation of cerebrospinal fluid
- Chiari malformation as the most common cause
- Post-traumatic cavities after spinal cord injury
- Consequences of meningitis and adhesions
- Cavities for spinal cord tumors
- Idiopathic options
Symptoms
The disease develops slowly over years. The early and most characteristic sign is a decrease or complete loss of pain and temperature sensitivity in areas similar to a jacket or half-jacket: hands, forearms, shoulders, upper chest and back. At the same time, a person feels the touch. Because of this, painless burns and cuts appear. Later, weakness and loss of weight in the muscles of the hands, pain in the neck and arms, increased tone in the legs, and sweating problems occur. In children and adolescents, syringomyelia often manifests itself as a rapidly progressive curvature of the spine.
- Loss of pain and temperature with intact sense of touch
- Painless burns and cuts on the hands
- Weakness and weight loss of hand muscles
- Aching pain in the neck, shoulders and arms
- Stiffness and weakness in the legs
- Scoliosis in children and adolescents
- Sweating disorders
Diagnostics
The main method is magnetic resonance imaging of the spinal cord, which directly shows the cavity, its length and width. The area of transition between the skull and the spine must be examined to identify a Chiari malformation, as well as the brain to exclude hydrocephalus. If a tumor is suspected, contrast is used. Special modes allow you to evaluate the movement of cerebrospinal fluid, which is important for planning surgery. A neurological examination documents areas of impaired sensitivity to monitor dynamics.
- MRI of the cervical and thoracic spinal cord
- MRI of the brain and craniovertebral junction
- MRI with contrast for suspected tumor
- Assessing Cerebrospinal Fluid Movement
- Neurological examination with sensitivity mapping
- X-ray of the spine for scoliosis
Treatment
If the cavity is small, there are almost no symptoms and the condition is stable, observation with repeated MRIs is chosen. When symptoms increase, the main approach is to eliminate the cause of the fluid outflow disorder. In case of Chiari malformation, an operation is performed to expand the space in the foramen magnum, after which the cavity is reduced in many patients. In post-traumatic and adhesive forms, the patency of the liquor passages is restored or drainage is installed. Medications cannot remove the cavity, but they help control pain and spasticity.
- Dynamic observation with repeated MRI
- Surgery for Chiari malformation
- Restoring the patency of the liquor pathways
- Drainage of the cavity in some cases
- Drugs for neuropathic pain
- Treatment of spasticity
- Rehabilitation and physical therapy
Safety at home
Since a person does not feel pain and temperature in certain areas, the risk of injury and burns increases dramatically. Simple rules significantly reduce this risk: check the water temperature with a thermometer or elbow, do not carry hot dishes with bare hands, use oven mitts and gloves, and inspect your hands daily. It is important to avoid straining, lifting heavy objects, and tilting the head suddenly, as this increases fluid pressure and may worsen symptoms. Any new complaints should be discussed with a neurologist rather than waiting for a scheduled visit.
- Check the water temperature before washing
- Use gloves and oven mitts
- Check your hands daily for wounds and burns.
- Avoid heavy lifting and straining
- Be careful with heaters and hot dishes
- Timely treatment of any skin damage
- Regular monitoring by a neurologist