Syringomyelia

Syringomyelia is the formation of a fluid-filled cyst (syrinx) within the spinal cord. The most common site is the cervical spine in the neck region. As the syrinx grows, it presses on the spinal cord and interferes with the transmission of nerve impulses. TYPES--- IT IS OF 3 TYPES 1 Congenital brain defects such as Arnold-Chiari malformation. The bottom part of the brain (cerebellum) lies in the upper part of the neck instead of within the skull. This obstructs the flow of cerebrospinal fluid. 2Injury to the spinal cord including trauma, ruptured aneurysm, infection (such as HIV), certain degenerative diseases or some brain tumours. The cyst forms at the damage site. 3Idiopathic syringomyelia the cause isunknown. Formation of the cyst Cerebrospinal fluid normally circulates around the brain and spinal cord. If the flow of cerebrospinal fluid is obstructed and turned back on itself, a cyst (syrinx) may form. The cyst may be small at first, but the differences in pressure between the skull and spinal cord gradually force cerebrospinal fluid into the cyst. Over time, the cyst grows larger and presses on the spinal cord. This can eventually damage the nerves. Syringomyelia usually progresses slowly over years, but symptoms can sometimes advance rapidly after straining or coughing. This is because the temporary increase in cerebrospinal pressure forces fluid into the cyst. Symptoms Pain and weakness in the back, shoulders,arms or legs. Headaches. Reduced skin sensations, such as not being able to feel extremes of heat and cold. Loss of sensation in the hands, including sensations of pain. Muscle atrophy (wasting), usually beginning in the hands and spreading to include the arms and shoulders. Severe pain in the shoulders and neck. Uncoordinated movement Diagnosis methods The symptoms of syringomyelia can mimic those of other conditions, so diagnosis can be difficult. Some of the tests for syringomyelia include: Medical history. Physical examination. Magnetic resonance imaging (MRI). Computerised tomography (CT) scans. Electromyography (to test muscle strength).

Tests of cerebrospinal fluid pressure. Lumbar puncture (to take a sample of cerebrospinal fluid). Treatment options Treatment depends on the cause and severity of the condition but may include: Wait-and-see approach if the cyst is small and not causing any symptoms, your doctor may prefer to simply monitor the condition. Medications syringomyelia cant be treated with drugs, but pain killers and muscle relaxants may help to ease some of the symptoms. Shunting a thin tube is inserted into the cyst to drain the fluid into the abdominal cavity. The shunt contains a one-way valve to prevent backflow. This type of treatment is often used if hydrocephalus (build-up of cerebral fluid inside the brain) is also present. Surgery to remove the tumour, or repair the damage caused by the trauma. In the case of Arnold-Chiari malformation, surgery aims to give the cerebellum more room in the base of the skull and neck, and improve the flow of cerebrospinal fluid at the same time. PHYSIOTHERAPY MANAGEMENT AIM-= 1 maintainance of range of motion

2 improve the strength of the muscle 3 care of anesthetic hand 4 develop co-ordination if the patient has ataxia due to involvement of cerebellumas in case of Arnold chiari type 1 malformation
To improve weakness and decreased function in their arms and/or legs, a comprehensive stretching program is critical to maintaining range of motion in the joints. Occupational and physical therapists instruct individuals and their family members on how to safely stretch the arms and legs. The occupational and physical therapists create a strengthening program to maintain functional abilities for the arms and legs. All strengthening exercises are performed to the individual's tolerance Education about the disease process helps explain the expected prognosis of the disease. Individuals also learn to prevent secondary problems such as the formation of decubitus ulcers that may result from decreased skin sensation. Individuals or their caregivers learn to inspect the skin for irritation or skin breakdown and learn to keep the skin dry and tell their physicians about any skin irritation. Individuals may have impaired coordination with syringomyelia. physical therapy assign fine motor coordination exercises and work on gross motor coordination.

Both sitting and standing balance are important in physical therapy. For example. Physical therapists may focus on standing balance to help preserve the ability to walk and work on dynamic sitting balance to promote dressing and grooming abilities The main focus of physical is to maximize functional capabilities. Occupational therapists teach individuals skills such as getting in and out of the shower, dressing, and meal preparation. They may order equipment such as a tub seat, a long-handled shoehorn, or kitchen utensils with thick handles to make these tasks easier. Physical therapists teach skills such as getting in and out of bed, walking, or using a wheelchair. They may order equipment such as a trapeze bar to hang over the bed, crutches or a cane, or self-propelled or power wheelchairs, as appropriate.. (. Exercises and other mobilization activities that produce effects like the Valsalva maneuver should be avoided until normal CSF flow has been restored.)