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For further information, see CMDT Part 24-27: Syringomyelia

Key Features

  • Destruction of gray and white matter adjacent to the central canal of the cervical spinal cord leads to cavitation and fluid collection within the cord

  • Associated with Arnold-Chiari malformation, sometimes with accompanying meningomyelocele

  • Cord cavitation may also occur with cord injury or neoplasm at any level of the cord

Clinical Findings

  • Cervical lesions

    • Segmental atrophy, areflexia, and loss of pain and temperature appreciation in a "cape" distribution owing to the destruction of fibers crossing in front of the central canal in the mid-cervical spinal cord

    • Often there is thoracic kyphoscoliosis

  • A pyramidal and sensory deficit may be present in the legs

  • Upward extension of the cavitation (syringobulbia) leads to dysfunction of the lower brainstem and thus to bulbar palsy, nystagmus, and sensory loss over one or both sides of the face


  • CT scans reveal

    • Small posterior fossa

    • Enlargement of the foramen magnum

    • Other associated skeletal abnormalities at the base of skull and upper cervical spine

  • MRI reveals

    • Syrinx

    • Caudal displacement of the fourth ventricle and herniation of the cerebellar tonsils through the foramen magnum

  • Focal cord enlargement is found at myelography or by MRI in patients with cavitation related to past injury or intramedullary neoplasms


  • Treatment of Arnold-Chiari malformation with associated syringomyelia is by suboccipital craniectomy and upper cervical laminectomy, with the aim of decompressing the malformation at the foramen magnum

  • In cavitation associated with intramedullary tumor, treatment is surgical, but radiation therapy may be necessary if complete removal is not possible

  • Posttraumatic syringomyelia is also treated surgically if it leads to increasing neurologic deficits or to intolerable pain

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