Diagnosing dogs with SM
While there are numerous symptoms that can strongly suggest a cavalier has syringomyelia, unfortunately few of these are so distinct that diagnosis can be made on the basis of symptoms alone, and many symptoms are also common to other conditions. There is only one way of making a definitive diagnosis -- an MRI, or magnetic resonance image, which at this time is generally a costly procedure requiring a general anaesthetic for the dog. There are, however, some low cost MRI screening programs available in the US and UK (see Low Cost MRIs). However, some signs are distinctive enough to strongly suggest SM and a practitioner may wish to use Dr Clare Rusbridge’s treatment algorithm to trial medications to see if symptoms improve, especially where MRI cost is prohibitive. A vet will want to work with a neurologist’s advice on this approach.
A diagnosis should be made by a qualified specialist (generally, a veterinary neurologist). A diagnosis should always come from a specialist who can professionally interpret a scan, then advise on the possibilities for treatment. A vet does not have the specialist knowledge of this condition that is needed for treatment, as many treatments are experimental at this time and some involve human medications. Vets should contact a vet neurologist for guidance.
As there are other conditions with similar symptoms, a vet should never presume a dog has SM and advise an owner to consider euthenising a dog because SM is supposedly untreatable! A responsible vet will always work to eliminate all other possible diagnoses and then refer to a specialist.
Even if you do not want to have an MRI done on your cavalier, you should have a neurologist see your cavalier if you and your vet suspect SM.
A neurologist can perform other simple tests to see if the cavalier exhibits signs that it has neurological difficulties that might be SM-related and may give a diagnosis on the basis of clinical symptoms, and may also suggest treatments. If you are very sure you will not consider surgery as an option, and your neurologist feels clinical signs lean towards an SM diagnosis, you can consider asking for a treatment approach without an MRI (eg medication), if this is acceptable to the neurologist.
* Many vets are reluctant to increase medications if initial doses do not help -- but as Dr Rusbridge’s algorithm notes, recommended doses are STARTING doses for drugs like gabapentin (Neurontin) or pregabalin (Lyrica). Most cavaliers need higher doses than the initial trial dose, and will need dosages increased over time, and adjustments made to the ‘cocktail’ of medications.
Please do not allow a cavalier to go untreated because you do not want an MRI or are unsure if you can afford one. SM can be a very painful condition and a range of medications can make the cavalier's life far more comfortable. Some of these medications are very inexpensive.
In this section, you can find:
* a step by step approach on what to do if you think your cavalier might have SM: Is this SM?
* leading SM researcher Dr Clare Rusbridge's introduction to SM for vets and pet owners: Canine Chiari-like Malformation and Syringomyelia (you can also download it as a PDF) or listen to a podcast (sound file) of her basic overview of CM/SM.
* an extensive list of possible symptoms as reported by vets, neurologists and owners of affected dogs: Symptoms (you can also download it as a Word file)
* view video clips of affected dogs with different symptoms and degrees of affectedness: Videos
* Find a list of board certified veterinary neurologists in North America, the UK and a few other countries: Neurologists
* Learn about MRIs and how they are used to diagnose SM, and view MRIs of affected and clear cavaliers: MRIs
* Find out about some special, low cost MRI screening clinics for dogs in the US and UK: Low cost MRI clinics
* Learn more about PSOM, primary secretory otitis media, an ear condition similar to 'glue ear' in children than can cause symptoms similar to SM: PSOM
One extensive problem for SM dogs is the length of time it can take for someone to finally recognise the dog has syringomyelia, which is normally a very rare condition in most dogs. Thus a dog can suffer for weeks, months or years as its syringomyelia is misdiagnosed and wrongly treated -- usually as allergies, back problems, ear infections, or sprains. Most vets will never have seen a case, and even many neurologists are unfamiliar with it, or unaware of the level of affectedness in cavaliers. You can make a difference! Downloading and print out the symptoms document, Dr Clare Rusbridge's Canine Chiari-like Malformation and Syringomyelia, and Dr Rusbridge's treatment recommendations and bring them to your vet for their files.