It is a disorder characterized by the presence of a cyst or cavity in the central part of spinal cord ,the cyst called as syrinx..
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It is a disorder characterized by the presence
of a cyst or cavity in the central part of spinal
cord ,the cyst called as syrinx. When it affect the brainstem, the condition is called syringobulbia. HISTORY
It usually progresses slowly .symptoms depend primarily on
the location of the lesion within the neuraxis. Clinical manifestations include the following:
Sensory: Dissociated sensory loss
Motor: Damages the motor neurons & cause muscle atrophy Autonomic: Impaired bowel & bladder functions, sexual dysfunction may develop in long-standing cases. Extension of syrinx: A syrinx may extend in to medulla producing syringobulbia Other manifestations: painless ulcers, edema, neurogenic arthropathies. Scoliosis is seen sometimes. Acute painful enlargement of shoulder associated with destruction of head of humerus. PHYSICAL
Diminished arm reflexes
Lower limb spasticity, paraparesis, hyperreflexia, Dissociated sensory impairment Brainstem signs are common The syrinx may extend in to the brainstem affecting cranial nerves or cerebellar function SYRINGOMYELIA WITH FOURTHVENTRICLE COMMUNICATION. DUE TO BLOCKAGE OF CSF CIRCULATION. DUE TO SPINALCORD INJURY. SYRINGOMYELIA & SPINAL DYSRAPHISM. DUE TO INTRAMEDULLARY TUMORS. IDIOPATHIC. Estimated prevalence of disease is about 8.4 cases/100000 people. SEX – More frequently in men than women AGE – Usually beginning in young adulthood 1. ETIOLOGY ASSOCIATED WITH CRANIOVERTIBRAL JUNCTION ABNORMALITIES: a) Bony abnormalities. b) Soft tissue masses of abnormal nature. c) Cerebellar tonsils. d) Chiari malformation. e) Membranous abnormalities such as arachnoid cyst, vascularised membranes. 2. ETIOLOGY NOT ASSOCIATED WITH CRANIOVERTEBRAL JUNCTION ABNORMALITIES
a)Arachnoid scarring related to spinal trauma.
b)Arachnoid scarring related to meningeal inflammation. c)Arachnoid scarring related to surgical trauma. d)Sub arachnoid space stenosis due to spinal neoplasm. e)Idiopathic. Patients may experience chronic pain, abnormal sensations and loss of sensation particularly in hands. Syrinx may also cause disruptions in parasympathetic and sympathetic nervous system, leading to abnormal body temperature or sweating, bowel control issues. In case of syringobulbia, vocal cord paralysis, tongue wasting, trigeminal nerve sensory loss. Rarely bladder stones can occur . NEUROSURGEON PSYCHIATRIST UROLOGIST PHYSIOTHERAPIST OCCUPATIONALTHERAPIST RECREATIONALTHERAPIST MAGNETIC RESONANCE IMAGING [MRI] This will show the syrinx in the spine, or presence of a tumor. ELECTROMYOGRAPHY [EMG] This measures the muscle weakness. COMPUTED AXIAL TOMOGRAPHY [CT] Shows the presence of tumors. MYELOGRAM Syrinx seen as a thin light grey shape, inside the spinalcolumn MEDICATIONS NSAIDs – Ibuprofen[1200-1800mg po-6h] Aspirin[325-650mg po -6h] Naproxen, Indomethacin,Pioroxicam, Mefenamicacid. MUSCLE RELAXANTS Methocarbamol[1.5gm po qid ] SURGICAL CARE Sub occipital cervical decompression Laminectomy and Syringotomy Shunts Fourth ventriculostomy Neuroendoscopic surgery Percutaneous needle Syringomyelia is a disorder in which a cyst or cavity forms within the spinal cord. The exact pathophysiology is unknown. It can be diagnosed by MRI, EMG, CT scan. No medical treatment is given. Identifying the underline cause of Syrinx formation is very important. The management of pain due to Syringomyelia is best accomplished by a multi-disciplinary approach.
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