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Thread: Understanding a pre-syrix

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  1. #1
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    Default Understanding a pre-syrix

    Hey everyone! It's been a while!!

    As you know I adopted a 6 year old cavvie to add to Brooklyn and I's family about 5 months ago - well, we had o have him MRI'ed recently as he has been head rubbing and randomly yelling and showing other odd behaviours that we could not explain in any other test.

    Well, his MRI actually came back pretty good (better than I thought!) but he has what the neuro is calling a pre syrinx in the cervical spine through the C4 and C5.

    Can someone help me understand more about a "pre syrinx"? We are putting him on 100mg of Gabapentin three times a day to start, as she is unsure if the pre syrinx is causing pain or not. Any one familiar with this?

    He has no CM and his ventricles are good too.

    Any thoughts would be so helpful - I love this little guy so much.

    Thank you!

  2. #2
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    Here is his MRI image


    Toby MRI Image by kelseykakes5, on Flickr

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    I'm certainly not an expert, and we have many on this forum who truly are SM experts. But I'll put forward my best understanding of a pre-syrinx. I'm a very visual person, so everything gets described in terms of images.

    As best I understand a "pre-syrinx" is an area that has signs of moving towards being a true syrinx, and will probably get there if allowed to continue. In my mind I always see the meteorologists tracking storms as they come across the Atlantic (New Orleans native, this is probably a very culturally constrained view); the storms start as just some clouds milling around together, and then build. Through satellites they can watch as the little puff of clouds forms and develops into a major hurricane. The same with a syrinx, a pre-syrinx would be sort of at the same stage as a tropical depression or tropical storm, where they can see the organization and pressure changes, but it isn't big or strong enough to be considered a full syrinx.

    I hope that makes sense.

    Edited to add: I believe the approach is to treat the symptoms, rather than the "syrinx"; so if he is having problems, even with a "perfect" MRI, then the right thing to do is to try to relieve his pain, and see how he responds.

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    Good post Soushiruiuma -- like the meteorological explanation and the note at the end to treat symptoms and not be too concerned about the status of the syrinx.

    BrooklynMom, so sorry you are going through this. Hopefully things will stay where they are -- in an older dog with a presyrinx, odds are good it won't get a lot worse -- and you may actually be getting most of the symptoms from CM not SM (I would think this is the case -- maybe your neurologist could email Clare Rusbridge?). So yes, treat for the symptoms.

    A pre-strinx is indeed the sign of a possible syrinx developing, a slight dilation (expansion) in the spinal cord that is not yet large enough to actually be considered a syrinx. I'd strongly recommend getting Toby on a CSF inhibitor as well, as Clare Rusbridge has occasionally seen prexyrinxes reduce or disappear from using a CSF inhibitor (eg cimetidine -- neurologists are not recommending frusemide any longer). For CM pain sometimes a CSF inhibitor works better than gabapentin. So you might try the CSF inhibitor first for two weeks and if discomfort isn't resolved, add back the gabapentin? I know this is the route Dr Rusbridge has taken with CM dogs (and in accordance with her own treatment algorithm). I am sure your neurologist is aware of her website and materials.

    Let us know how he does!
    Karlin
    Cavaliers: Jaspar Lily Tansy Libby Mindy
    In memory: Lucy Leo
    Cavalier SM Information site:www.smcavaliers.com

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    My understanding of a pre syrinx is that it is an accumulation of fluid within the spinal cord substance,rather than having formed a distinct fluid filled cavity(syrinx).
    Clare Rusbridge has a very useful FAQ section on her website which explains all the definitions and terminology about the full spectrum of CM/SM and it's well worth taking a look through it.
    http://www.veterinary-neurologist.co.uk/part1.htm
    If he were my dog,I'd be happy to try the CSF inhibitor and see if that made a difference.I guess just use the minimum firepower to control the symptoms rather than weighing in with heavy duty meds...It's not a bad scan for a six year old and he may never progress to full syrinx formation.I would also keep an open mind about other possible conditions which may be causing his symptoms.
    Sins
    Sharing my sofa with Holly, Ivy,Lilly and Hazy.. and never forgetting our beautiful Daisy who reached the bridge too soon.

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    Yep that's it!

    From Clare's FAQ:


    What is pre syrinx?

    The first stage of syrinx development appears to be (interstitial) oedema i.e. fluid within the spinal cord typically around a dilated central canal– so called pre-syrinx. The fluid is within the spinal cord substance rather than coalesced into distinct cavities.
    There's also an image. And yes would def recommend everybody who owns this breed, reading the full FAQ to be up to date on knowledge about the condition.

    BrooklynMom is already acquainted with the stages of SM though...
    Karlin
    Cavaliers: Jaspar Lily Tansy Libby Mindy
    In memory: Lucy Leo
    Cavalier SM Information site:www.smcavaliers.com

  7. #7
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    Thanks everyone for your thoughts and info!
    I might have misheard about no CM...have a call with my neuro in one weeks time so I will ask her that specifically. My whole appointment after the MRI was a bit of a blur with emotions etc. so let me ask again to make sure. We are very lucky with our neuro, she is the leading neurologist in Australia, and the leader in SM with the Brussels Griffon breed...we are very lucky to have her, but like with specialists at times, they speak in speciist talk! So what makes sense to her or is easy to wrap her head around can wash over us. So I have a big list of follow-ups she is SO nice and really easy to talk to, so I will know more next week.

    Also, like you all said, her main point was that regardless of the scan, we need to treat the pain and the symptoms - so we are doing that. He seems better on Gabapentin, but sometimes will have break through head rubbing/digging episodes - would this indicate another med is needed or a higher dose of Gabapentin? You can definitely tell when it is wearing off.

    I know so much (almost too much!) about SM and CM that it is hard not to get swept away, but I try to always think like him and live day by day And for one, he is certainly much happier on meds! Bless.

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