Station 3.19: Syringomyelia

Question 1

clinical signs

What are the clinical signs of Syringomyelia?

Syringomyelia

Examine this patient’s upper limbs neurologically. He has been complaining of numb hands.

Answer 1

• Weakness and wasting of small muscles of the hand
• Loss of reflexes in the upper limbs
• Dissociated sensory loss in upper limbs and chest: loss of pain and temperature sensation (spinothalamic) with preservation of joint position and vibration sense (dorsal columns)
• Scars from painless burns
• Charcot joints: elbow and shoulder

Question 2

clinical signs - additional signs

What are the additional signs of Syringomyelia?

Syringomyelia

Examine this patient’s upper limbs neurologically. He has been complaining of numb hands.

Answer 2

• Pyramidal weakness in lower limbs with upgoing (extensor) plantars
• Kyphoscoliosis is common
• Horner’s syndrome (see Ophthalmology section)
• If syrinx extends into brain stem (syringobulbia) there may be cerebellar and lower cranial nerve signs

Question 3

Discussion

What is Syringomyelia?

Syringomyelia

Examine this patient’s upper limbs neurologically. He has been complaining of numb hands.

Answer 3

• Syringomyelia is caused by a progressively expanding fluid filled cavity (syrinx) within the cervical cord, typically spanning several levels.
• The signs may be asymmetrical.
• Frequently associated with an Arnold–Chiari malformation and spina bifida.
• Investigation = spinal MRI.

Syringomyelia causes and effects

Question 4

Discussion - charcot joint (neuropathic arthropathy)

What is charcot joint (neuropathic arthropathy)?

Syringomyelia

Examine this patient’s upper limbs neurologically. He has been complaining of numb hands.

Answer 4

• Painless deformity and destruction of a joint with new bone formation following repeated minor trauma secondary to loss of pain sensation.
• The most important causes are:
  ⚬ Tabes dorsalis: hip and knee
  ⚬ Diabetes: foot and ankle
  ⚬ Syringomyelia: elbow and shoulder
• Treatment: bisphosphonates can help

Question 5

Discussion - cervical roots and upper limb dermatomes

Informative card - cervical roots and upper limb dermatomes

Syringomyelia

Examine this patient’s upper limbs neurologically. He has been complaining of numb hands.

Answer 5

cervical roots and upper limb dermatomes