Syringomyelia Flashcards Preview

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Flashcards in Syringomyelia Deck (13):
1

 

 

What is syringomyelia?

 

A syrinx is a fluid-filled tubular cavity in or close to the central canal of the spinal cord

2

 

 

What is the typical age of onset of synringomyelia?

 

 

30 years old

3

 

 

What are causes of syringomyelia?

  • Blocked CSF circulation
    • Arnold-chiari malformation
    • Basal arachnoiditis
    • Basilar invagination
    • Masses
  • Following myelitis
  • Following trauma
  • Ruptured AV malformation
  • Spinal tumours - fluid secretion from neoplastic cells

4

 

 

What are symptoms of syringomyelia?

 

  • Upper limb pain exacerbated by exertion/coughing
  • Numbness
  • Weakness

5

 

 

What is Arnold-Chiari malformation?

 

 

Cerebellum herniates through foramen magnum

6

 

 

What is basilar invagination?

 

 

Where the top of the odontoid peg migrates upwards, causing foramen magnum stenosis +/- medulla oblongata compression

7

 

 

What are signs seen in syringomyelia?

 

  • Suspended area of dissociated sensory loss
  • Wasting/weakness of hands +/- claw hand spreading to arm -> shoulders-> respiratory muscles
  • Horner's syndrome
  • UMN leg signs
  • Body asymmetry
  • Limb hemihypertrophy
  • Unilateral hand/foot enlargement

8

 

 

What is dissociated sensory loss?

 

Absent pain and Temperature sensation, with preserved light touch, vibration and proprioception

9

 

 

Why do you get dissociated sensory loss in syringomyelia?

 

 

Due to pressure from the syrinx on the decussating anterolateral pathways in a root distribution reflecting the location of the syrinx (e.g. cervical syrinx causes sensory loss over trunk and arms)

10

 

 

What is thought to causes unilateral large feet/hands, body asymmetry or limb hemihypertrophy in syrinomyelia?

 

 

Release of trophic factors via anterior horn cells

11

 

 

What are features of syringobulbia?

Brainstem involvement

  • Nystagmus
  • Vertigo
  • Bulbar palsy - Tongue atrophy/fasciculations, Dysphagia, Pharyngeal/palatal weakness, dysarthria, hoarseness
  • Horner's syndrome
  • CNV palsy

12

 

 

What investigation would you consider doing in someone with suspected syringomyelia?

 

 

MRI - shows syrinx

13

 

 

How would you manage someone with syringomyelia?

 

  • Surgical Decompression
    • ​Foramen magnum - Arnold-Chiari malformation - promote free flow of CSF