Syringomyelia

Question 1

What is a fairly classical history of syringomyelia?

Answer 1

A history of painless burns, cuts etc

Also poorly localised unpleasant pain

Question 2

Will a patient with syringomyelia have good muscle bulk in the intrinsic hand muscles and muscles of the forearm?

Answer 2

No

Wastage will be seen

Question 3

With syringomyelia, you will sometimes see wastage of the intrinsic hand muscles. If there were also fasciculations, what would be your DDx?

Answer 3

MND

Question 4

Are tone and deep tendon reflexes diminished in syringomyelia?

Answer 4

Yes

Question 5

What sensory changes will a patient with syringomyelia show?

Answer 5

Reduced pain and temperature sensation

Intact vibration, light touch and proprioceptive senses

Question 6

Is vibration sense intact throughout the entire clinical course of syringomyelia?

Answer 6

No

Vibration sense will be lost at the later stages

Question 7

What is the usual age of onset of syringomyelia?

Answer 7

Mean age is 30 years

Affects both genders equally

Question 8

What is the typical temporal progression of syringomyelia?

Answer 8

Symptoms may be static for years, before worsening suddenly eg on coughing or sneezing, when pressure increase causes extension of the syrinx (eg into the brainstem; syringobulbia)

Question 9

What can cause the formation of a syrinx?

Answer 9

Blocked CSF circulation typically with decreased flow from basal posterior fossa to caudal space (eg Chiari, basal arachnoiditis, subarach haem, masses, basilar impression/invagination)

Less commonly can develop after myelitis, cord trauma or rupture of an AV malformation

Question 10

Why do we see decreased pain and temp sensation in syringomyelia?

Answer 10

Because of pressure on the decussating anterolateral pathways in the cspine

Question 11

Do you see a root distribution of symptoms that can localise the lesion in syringomyelia?

Answer 11

Yes

eg for typical cspine syrinx, you see sensory loss over trunk and arms