Syringomyelia in Cavaliers

Is my pup’s scratching SM?

Cocoa falling over as she air scratches.

Syringomyelia, or SM, is a serious neurological disease found in our Cavalier King Charles Spaniels.  It’s considered an inherited disease that is progressive and can vary in the degree of seriousness.  While the Cavalier is the single most affected breed (another handful of breeds also experience it) and it is fairly common among them, by no means are most of our dogs going to suffer from it.

First, since it’s a mouthful, let’s address the pronunciation as it’s so much nicer to appear a little smarter in front of your vet.  Say it as Suh-ringo-my-eelia.  The condition is complicated, as it is related to COMS (Caudal Occipital Malformation Syndrome), Chiari-like Malformation, and even Occipital Dysplasia.  The essence of these diseases is that the dog’s skull is too small for their brain. 

Specifically in SM, there is not enough room in the space of the skull at the back of the brain, and this interferes with the flow of spinal fluid to the rest of the body.  This constraint causes pockets of fluid, called syrinxes, to be created which causes a sort of phantom pain, thought be the pressure on the nerves, mostly around the shoulders and neck.

The most common initial symptom is what is called “air scratching,” with the rear legs scratching on or maybe just near the neck and ears. 

The symptoms can include:

•          That excessive scratching, often coming on during walks on a leash.  It can appear as an awkward gait, with the dog falling over as it scratches in mid-air.  They may walk with an apparent curve to one side of their body.  A harness will help with some of this during walks.  Touching the dog's neck or ears can sometimes bring on scratching as the area may be sensitive if the disease advances.

•          It may cause pain that makes the pup whine, yelp, or whimper for no apparent reason.  Restlessness might be seen as they may shift constantly while trying to rest.  Even weather changes can bring on episodes.

•          Limping or a general lack of coordination, and maybe they have difficulty getting up and down off a couch or bed.

•          Head shaking and rubbing, or excessive rutching and digging at covers and beds in a somewhat frantic manner.

In a more seriously progressed disorder, somewhat rare, it can lead to greater neurological issues, resulting in nerve damage and even seizures.

With some of these symptoms looking like what would be common behavior in many dogs, it can be difficult to diagnose early.  But it’s worth watching our Cavaliers closer if you suspect the possibility of Syringomyelia.  And there are, of course, other ailments that can cause some of the symptoms, including ear infections, skin conditions, or mites or fleas.

There’s also Primary Secretory Otitis Media (PSOM), also known as "glue ear," another disease found almost exclusively in Cavalier King Charles Spaniels.  This is an inflammation of the dog's middle ear causing a bulge that carries many similar symptoms and can often lead to deafness.

With such a baffling range of possibilities, it’s important that the vet you choose for this diagnosis effort be well familiar with Cavaliers, as many normal and well-qualified veterinarians just aren’t familiar with these diseases seldom found in most breeds. 

Indeed, consultation with a good board-certified veterinary neurologist is highly recommended, if not mandatory for any dog believed to have Syringomyelia.  Web searches will turn up a variety of options, such as the 26 Florida-based veterinary neurologists at VetSpecialists.com.

It’s worth mentioning that CRF is a big believer in specialists for conditions such Cardiology, Ophthalmology, Oncology, as well as Neurology.  We have had dozens of interactions with neurological specialists, though with decidedly mixed results.  We’ll say that often the best advice is to trust your gut and don't be afraid to ask questions or get 2nd opinions.

So, SM can be found in either sex and all colors and at pretty much any age.  So how do we know for sure if it’s Syringomyelia?  The only way to absolutely confirm a diagnosis is by getting them in for an MRI (Magnetic Resonance Imaging), enabling that pocket of fluid (syrinx) to be visualized in an MRI’s “slices” of images.  However, that’s an expense we seldom endorse, as after a good neuro consult, they often are willing and able to treat and see how a dog responds without an MRI for confirmation, because if it walks like a duck and quacks like a duck, it probably is a duck. 

So how can we help these poor pups?  Medication management can help a lot, though note none will ultimately “cure” your dog.  Drugs sometimes prescribed might include Non-Steroidal Anti-Inflammatories (NSAIDs) like Rimadyl, Gabapentin (aka Neurontin), Omeprazole (aka Prilosec), and others.  Here we’ll remind you, please don’t attempt to apply medications without the direction of your veterinarian.  Dosing of these is, perhaps obviously, at much lower levels than you would take.  Acupuncture is also a treatment that seems to help some dogs.

Truly severe cases of SM, particularly at a very young age, might suggest a surgery.  This is where a part of the skull’s bone at the rear is removed to open the space and remove the pressure.  Yet even this may only be temporary as the condition is capable of returning some months or years later.  And it’s expensive and rarely called for or needed. 

We’ll stop here and, as usual, defer you to your appropriately expert Cavalier vet specialist, but we just wanted to paint the range of this disease.  Insert here all the fitting disclaimers that we are not to be considered licensed professionals.

As challenging as that all may sound, Cavaliers with Syringomyelia most often lead long and happy lives.  Please don’t consider this deep dive into Syringomyelia as worrying as it might sound.  SM in most Cavaliers is not a highly progressed ailment. 

And there are many accommodations we can make for them.  A harness rather than a collar is called for in any leashed activities.  An elevated water and feeding bowl will keep some of that pressure off.  Maybe a stroller allows you and perhaps any canine siblings to still get those walks in while not leaving anyone behind.  Steps will be a more comfortable way to get on and off the couch and bed.  Pay attention to how they react to being picked up.  And simply be watchful and take cues from your pup, they’ll generally let you know what’s comfortable.

Syringomyelia is an unfortunate attribute of the evolution of the Cavalier, though, lovers as they are, we know we wouldn’t trade them for the world. 

As always, we are wishing you the love of a Cavalier!

Syringomyelia and Chiari malformation are conditions found in humans as well. And May is Syringomyelia Awareness Month as promoted by the American Syringomyelia & Chiari Alliance Project at https://asap.org/.