Spinal Cord

Question 1

What is syringomyelia?

Answer 1

Syringomyelia is a chronic progressive disorder characterized by a fluid-filled cavity (syrinx) forming within the spinal cord, typically in the cervical or cervicothoracic region.

Can be acquired or congenital.

Congenital is the most common form and associated to a chiari malformation, specifically type I, where the cerebellar tonsils hang lower and protrude blocking the foramen magnum and the normal CSF flow.

Acquired can be due to spinal cord injury, post inflammatory, tumors.

The CSF is forced into the spinal cord canal and enlarges over time. As it enlarged it may compress the anterior comissure affecting decussating spinothalamic fibers, anterior horn leading to LMN weakness, lateral corticospinal tract and even dorsal columns (spared initially)

Question 2

Typical symptoms in syringomyelia?

Answer 2

• Cape like bilateral loss of pain and temperature sensation due to anterior commissure involvement. Especially in arms and shoulders.
• Headache
• LMN signs in upper limbs like atrophy of hands.
• loss of reflexes
• Scoliosis

Question 3

Imagining for syringomyelia?

Answer 3

On saggital MRI Central T2 hyper intensity in the central portion corresponding to the fluid filled syrinx.

Question 4

Treatment for syringomyelia?

Answer 4

Treatment is based on treating the chiari malformation if it is present, draining the syrinx or removing the obstruction

Question 5

What is Horner syndrome?

Answer 5

It is a condition that affects the face and eye on one side of the body caused by a disruption of a nerve pathway in the sympathetic system.
It leads to constricted pupils, anisocoria, ptosis, anhidrosis.

Can be caused by different etiologies :

Damage to first order neurons can be due to stroke, tumor, syringomyelia.

Damage to second order neurons can be due to upper lobe lung cancer, schwannomas or surgery in chest cavity.

Damage to third order neurons can be due to carotid artery damage.