Syringomyelia Flashcards
What is a syrinx?
A tubular cavity in or close to the central canal of the cervical cord filled with CSF
In syringomyelia, the cavity may be static for years or may worsen fast - what can cause this?
Coughing or sneezing - increased pressure causes extension of the cavity e.g into brainstem (syringobulbia)
When is the mean age of onset?
30 years old
What can cause it?
Several causes: Chiari malformation- cerebellum herniates through foremen magnum Spinal cord tumours Meningitis Spinal cord injury
What is the classic presentation?
Cape like (neck and arms) loss of sensation to temperature, crude touch and pain but preservation of light touch, proprioception and vibration
- patients burn hand without realising
This is due to the crossing spinothalamic tracts in the anterior commissure of the spinal cord being the first tracts to be affected
Other symptoms and signs: Spastic weakness Paraesthesia Neuropathic pain Up going plantars Bowel and bladder dysfunction
What imaging should be done?
MRI spine and brain - look for chiari malformation, size of syrinx
What do the symptoms depend on?
The location and size of the syrinx
What is syringobulbia?
Fluid filled cavity within the medulla of brainstem - often an extension of the Syringomyelia but can be isolated
If the syrinx is not treated, what can happen over a number of years?
Scoliosis
How does the syrinx grow?
Grows outwards from the central canal
Can also grow longitudinally
Where does the spinothalamic pathway decussate?
At the level it enters
Primary neurone synapses in the grey matter of dorsal horn
Secondary neurone crosses over anterior white commissure - where the damage caused by the syrinx is
Are the symptoms seen bilaterally?
Yes
