Syringomyelia – At A Glance

Syringomyelia is a fluid filled cyst within the spinal cord. 

This cyst enlarges (vertically and horizontally) overtime and damages the spinal cord.

When syrinx extend up to the medulla, it is called as syringobulbia.

This will also produce the same picture of syringomyelia, in addition to that there will be….

  • Dysphagia
  • Dizziness
  • Nystagmus
  • Ataxia
  • Horner’s syndrome
  • Cranial nerves can be affected 
    •  Trigeminal nerve
  • Can affect the brain stem leading to respiratory failure and death

 
Causes Of Syringomyelia


Exact cause of syringomyelia is unknown

  • Congenital 
    • Chiari malformation 
      • The lower part of the brain pushes down into the spinal canal
  • Acquired
    • Spinal cord tumor
    • Meningitis


Clinical Features Of Syringomyelia
  1. Usually affects the cervical region 
  2. Slowly progressing disease
  3. Pain in the neck, shoulders, arms and back 
    • Seen early in the course of the disease 
  4. Initially affects the spinothalamic tracts as the syrinx will interfere with the decussation of the spinothalamic fibres, resulting in bilateral loss of….
    • Pain 
    • Temperature
    • This is called as a cape like or a shawl like distribution 
    • Dissociated sensory impairment
  5. Later when the syrinx advances. it will damage the motor neurones (LMN) in the anterior horn of the spinal cord (corticospinal tracts), leading to….
    • Muscle weakness – Spreading from hands to shoulders
    • Muscle wasting
    • Spasticity
    • Loss of reflexes
  6. Scoliosis
  7. Sensation of the posterior column typically remains intact, such as….
    • Vibration 
    • Proprioception
    • Fine touch 
    • Two point discrimination 
  8. Autonomic involvement is seen in advanced cases
    • Impaired bladder bowel function
 
 
Complications Of Syringomyelia

 

  1. Scoliosis
  2. Charcot joints 
  3. Burns
  4. Chronic pain 
  5. Paraparesis 
 
 
Investigations Of Syringomyelia
    • MRI of spin is diagnostic
      • Can reveal the syrinx
      • Presence of spinal cord tumor can be determined
      • Associated Chiari malformation 
 
 
Treatment Of Sryingomyelia
  • Predominantly surgical management
  • No medical treatment available 
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