The syrinx diagnosis

As I pointed out earlier, in the diagnostic work associated with the tissue mass, a syrinx was discovered in the spinal cord. This was the reason for the involvement of the neurosurgeon. He ordered a series of additional MRI scans to determine the depth of the syrinx and look for one of the possible causes. The initial thought was that a chiari malformation was in play. This is a narrowing of the hole in the base of the skull by the tonsils of the cerebellum. Results of those tests showed no malformation or at least not one that qualifies. Medicine is sometimes tricky stuff and although Tim's cerebellum was in this opening it wasn't extended far enough to qualify. On the other hand, they were clearly in that hole at the base of the skull but not really a causal candidate for the syrinx.

We were told the syrinx is not a normal element of the spinal cord. It is essentially a water column in the middle of the spinal cord made up of cerebral spinal fluid. This stuff "flows" in and around the brain and spinal column and when restricted can cause the syrinx to appear. Patients usually have some symptoms associated with a syrinx but Tim had none and continues to have none.

There was one more possibility for restricted flow and that could be some issue in the spinal column. To test this, Tim had a myleogram which is to inject a contrast medium into the lower spine and watch how it flows on a flouroscope. This test also showed no cause for the syrinx. So we were left with no answer other than to check again in a year and see if the syrinx changes size. In the meantime since Tim has no symptoms and he has a "lot of room" in the spinal column for a spinal cord that is "fatter" than normal, we'll end up waiting until next summer to check the status of the syrinx again.

Good news for this part of the journey.

If something changes, then we'll have another decision about a surgical proceedure (exploratory) to look for potential restrictions near the base of the skull that can only be seen this way. MRI scans as good as they are can't completely substitute for visual inspection.

--bob