Syringomyelia

Question 1

What is a syrinx?

Answer 1

A tubular cavity in or close to the central canal of the cervical cord

Question 2

What is the mean age of onset of syringomyelia

Answer 2

30yo

Question 3

What happens to cerebellum in arnold-chiari malformation

Answer 3

Cerebellum herniates through the foramen magnum

Question 4

What causes syringomyelia

Answer 4

Blocked CSF circulation with decreased flow from basal posterior fossa to caudal space
Basal arachnoiditis - after infection, irradiation or subarachnoid haemorrhage
Basilar invagination
Masses - cysts, rheumatoid pannus, cord trauma or rupture of AV malformation
Spinal cord tumours

Question 5

What are the signs of syringomyelia

Answer 5

Dissociated sensory loss - absent pain and temperature sensation with preserved vibration and joint position sense

Wasting/weakness of the hands +/- claw hand

Horner’s syndrome

UMN leg sings

Charcot’s joints in the shoulder/wrist due to lost joint proprioception

Question 6

What causes dissociated sensory loss in syringomyelia

Answer 6

Pressure from the syrinx on the decussating anterolateral pathway in a root distribution reflecting the location of the syrinx

Question 7

List the signs of Syringobulbia

Answer 7

Nystagmus
Tongue atrophy
Pharyngeal and palatal weakness

Question 8

What is Syringobulbia

Answer 8

Brainstem involvement

Question 9

How is syringomyelia managed?

Answer 9

MRI
Decompression at foramen magnum for Chiari malformations to promote free flow of CSF
Surgery may reduce pain and progression