Understanding a pre-syrix

[BrooklynMom]

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!

[BrooklynMom]

Here is his MRI image


Toby MRI Image by kelseykakes5, on Flickr

[Soushiruiuma]

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.

[Karlin]

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!

[sins]

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

[Karlin]

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...

[karen baker]

Very interesting, posts explaining the cm/sm scans, i think i,am beginning to comprehend it a little better, i,am used to working in theatres with people, i had ruby scanned in april 2012, and worry that maybe i,am not doing all i should be for her, shes not actually showing any neurological signs, she has psom which showed on mri, she is very deaf, in there opinion surgery is not very satisfactory, and relapses are frequent, thats ok, we are adapting!!! she has cm/sm the syrinx is very similar to the one posted earlier, but i worry that i may be missing something, on her scan its comments : Today, the syringomyelia is not severe, and no neurological signs are related to this condition. I feel sure that ruby is,nt showing any major issues in regards to pain, she will be 7 in march, but they did want to scan her lower back, but i declined, (BECAUSE OF THE EXSPENSE), as i thought she could have disk problems, she would have episodes of pain on jumping, climbing stairs,getting into car, she would yelp, but touch wood shes not had a problem for about a year, she does,nt run now, but will break into a little trot, but is quite happy to walk, but trails behind, i was told recently she has grade 2 heart murmer, she is 12kg, and has been on a diet for 6 months through the vets, the weight just won,t come off, shes on royal cannine for neutered adults and has 50grams in the morning and 50 grams in the evening, in contrast sadie my rescue cavalier, an ex breeeding bitch, seems to be fine, 8kg and runs like a whippet, she is,nt displaying any signs of health problems she is 8 years, not mri scanned at this moment in time, but has had a troubled past. Am i just looking for something to worry about? Karen, Ruby and Sadie x

[Karlin]

she would have episodes of pain on jumping, climbing stairs,getting into car, she would yelp, but touch wood shes not had a problem for about a year, she does,nt run now, but will break into a little trot, but is quite happy to walk, but trails behind,

Personally if she were my dog I'd think about talking to a vet or neurologist about trying her on some of the SM medications to see if they help. I do think she is showing neurological signs -- those would all be typical signs of some compromise/pain caused by CM/SM (yelping, difficulty jumping up, reluctance to run...). If she scanned with a syrinx of any size it is more likely I would think that this is affecting her than possible disk disease. Dogs do often grow to tolerate pain over time so this could be why she stopped showing signs with jumping, or maybe that particular pain eased...? But if she has disk disease this too should be diagnosed and treated -- often that can be done with an xray if pain returns.

I do think though that if she isn't willing to run, this is significant and should be looked into as she is compensating for some sort of ongoing pain, whether caused by CM/SM or disk disease.

[karen baker]

Thank you Karlin for you advice, it makes sense now you,ve explained, i think maybe i,ve been too accepting, in what i,ve been told, i would love to see my Ruby run again!! But there just seems to be so many drugs, that they have to take for this condition, i don,t want her to be in pain, and i want the best for her, how do i know exactly what is necessary, i don,t want her pumped with endless amounts of drugs, my vet suggested metacam once daily 10kg for 4 weeks, back in the summer, but to be honest i did not see any difference. Do you think i should pursue this further? karen

[Karlin]

Metacam rarely seems to works well on its own for CM or SM pain. I'd have your vet have a look at Clare Rusbridge's site (linked above) and consider trying some of the steps on her treatment algorithm if s/he feels there might be a relationship to Ruby's behaviour. Or ask to see a neurologist -- as she has been scanned, it should be possible to start her on a treatment programme, I think? Ruby is a relatively young dog to be unable now to run at all so I'd really think there would be a lot of scope for improving how she is feeling, whatever the cause.

Usually what would be done would be to try something like cimetidine for a couple of weeks; if no improvement try adding in gabapentin.

I've never found either of these medications affects in any negative way, my dogs that are on them. Of course there are always some risks to watch out for -- that's why Clare recommends annual blood tests just to monitor any changes. But Leo has had no issues at all in 8 years on these meds and they give him a very good quality of life. He can run and jump and play. I sure don't advocate overmedicating (or over-supplementing, for that matter) a dog -- but using meds to ease pain and give back quality of life is never over-medicating.

I'd also just want to add that some dogs are naturally not that playful with other dogs and a lot of adult dogs have no interest and are very annoyed by puppies, for example. Mine like to run and race but only two of them really play together (tug of war or fetching the same item back). I'd differentiate between unplayful behaviour that might just be an individual dog vs behaviours that could be or almost certainly are related to some physical disability or compromise (being reluctant to run, jump, interact). In other words, as relates to a separate thread, a dog that is simply a bit annoyed with puppies wouldn't immediately be a cause for concern to me! -- none of mine really likes puppies!! But a dog that is unhappy with many or most interactions, never is very playful or full of life, resists or totally avoids much activity, yelps now and then -- that would be a cause for concern that more is going on.