Syringomyelia vs Multiple sclerosis
How to tell Syringomyelia and Multiple sclerosis apart when a board question makes them look alike.
Syringomyelia is central cord cape-like dissociated sensory loss; MS is disseminated CNS demyelination in time and space.
Side by side
Syringomyelia causes a central spinal cord cavity with bilateral cape-like loss of pain and temperature, preserved vibration/proprioception early, LMN intrinsic hand weakness and wasting from anterior horn involvement as the syrinx expands, and possible Chiari I association.
Multiple sclerosis causes relapsing-remitting CNS demyelinating lesions separated in time and space, optic neuritis, internuclear ophthalmoplegia, sensory/motor episodes, and CSF oligoclonal bands.
A syrinx damages crossing anterior white commissure spinothalamic fibers near the central canal.
Autoimmune demyelination in CNS white matter disrupts conduction across brain, optic nerve, brainstem, and spinal cord lesions.
MRI spinal cord syrinx with dissociated pain-temperature loss supports syringomyelia.
MRI periventricular/juxtacortical/infratentorial/spinal lesions and CSF oligoclonal bands support MS.
The trap
Both can affect the spinal cord, so sensory modality pattern and lesion distribution decide.
The repair move
For cord sensory symptoms, ask whether pain-temperature is selectively lost from a central cord lesion or lesions are disseminated like MS.
Try a free question
CoreA patient has bilateral cape-like loss of pain and temperature over the shoulders and arms, preserved vibration and proprioception, intrinsic hand weakness and wasting, and MRI showing a cervical central cord cavity. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Syringomyelia. Cape-like dissociated pain-temperature loss with a cervical syrinx supports syringomyelia.
Why the other choices are tempting
- B. MS causes disseminated CNS demyelinating lesions rather than a central syrinx pattern.
- C. SCD affects posterior columns and corticospinal tracts from B12 deficiency.
- D. Brown-Sequard causes hemicord ipsilateral/contralateral split findings.
- E. Tabes dorsalis is late neurosyphilis dorsal column/root disease.
Flashcards
Tap a card to flip it.
What sensory pattern points to syringomyelia?
Cape-like loss of pain and temperature with preserved vibration/proprioception points to syringomyelia.
What tract fibers are first injured in syringomyelia?
Crossing spinothalamic fibers in the anterior white commissure are injured early in syringomyelia.
Quick answers
What is the fastest way to tell Syringomyelia from Multiple sclerosis?
Syringomyelia is central cord cape-like dissociated sensory loss; MS is disseminated CNS demyelination in time and space.
What is the key clue for Syringomyelia?
Syringomyelia causes a central spinal cord cavity with bilateral cape-like loss of pain and temperature, preserved vibration/proprioception early, LMN intrinsic hand weakness and wasting from anterior horn involvement as the syrinx expands, and possible Chiari I association.
What is the key clue for Multiple sclerosis?
Multiple sclerosis causes relapsing-remitting CNS demyelinating lesions separated in time and space, optic neuritis, internuclear ophthalmoplegia, sensory/motor episodes, and CSF oligoclonal bands.
What is the common trap with Syringomyelia vs Multiple sclerosis?
Both can affect the spinal cord, so sensory modality pattern and lesion distribution decide.