Syringomyelia Flashcards
What is syringomyelia?
Collection of CSF within the spinal cord
Syrinx is a tubular cavity in or close to the central canal of the cervical cord
What are causes of syringomyelia?
Blocked CSF circulation with reduced flow from posterior fossa to cuadal space
E.g. Arnold Chiari malforation (cerebellum herniates through foramen magnum
Basal arachnoiditis (after infection, irradiation, subarachnoid haemorrhage)
Basilar invagination
Masses (cysts, tumours)
Myelitis
Cord trauma
What is the classic presentation of syringomyelia?
Cape like (neck and arms) loss of sensation to pain and temperature but preservation of light touch, proprioception and vibration.
Patient who accidentally burn hands without realising
Due to crossing of spinothalamic tracts in anterior commissure o the spinal cord being first tracks affected
What are symptoms and signs of syringomyelia?
Dissociated sensory loss - absent pain and T sensation with preserved light touch, vibration and joint position sense due to pressure form the syrinx of the decussating anterolateral pathway in a toor distribution reflecting location of the syrinx - cape like
Wasting/weakness of hands ( then arms, shoulders, respiratory muscles_
UMN leg signs Body asymmetry Limb hemihypertrophy Horner's syndrome Charcot's joint in shoulder wrist Horner's syndrome due to compression of sympathetic chain
What is syringobulbia?
Fluid filled cavity in the medulla of the brainstem.
Often an extension of syringomyelia
Nystagmus Tongue atrophy Dysphasia Pharyngeal/palatal weakness 5th nerve sensory loss
What investigation?
MRI full spine
MRI brain for Chiari malforamtion
What is treatment?
Decompression
Shunt into syrinx
What is Arnold Chiari malformation?
Downward displacement or herniation of cerebellar tonsils through the foramen magnum
Congenital or acquired through trauma
Non communicating hydrocephalus may develop due to CSF obstruction
Headache
Syringomyelia
