Syringomyelia

Anatomy of spinal cord
The ventricular system
1. is a set of four interconnected cavities (ventricles) in the brain, where the cerebrospinal fluid (CSF) is produced. Within each ventricle is a region of choroid plexus.
2. Formation of CSF
  1. The cerebrospinal fluid is produced by the choroid plexus of the ventricles, which is a network of capillaries with fenestrated endothelial cells and specialized ependymal cells.
Ascending & descending tracts
1. Motor Pathway
  1. Pyramidal System
    1. Corticospinal tract
      1. Voluntary, skilled, discrete movements.
      2. UMN
        Neurons of the cerebral cortex in motor areas (pyramidal cells) giving descending fibers → converge in corona radiate →pass through posterior limb of internal capsule →fibers descend through basis pedunculi of the midbrain →then through pyramids of medulla.
      3. LMN
        Anterior horn of the spinal cord
2. Sensory Pathways
  1. Posterior white column
  2. Posterior (dorsal) spinocerebellar
  3. Anterior (ventral) spinocerebellar
  4. Lateral Spinothalamic
  5. Anterior Spinothalamic
Reflexes
1. A reflex is an involuntary and instantaneous movement in response to a stimulus.
2. Components
  1. 1. Stimulus 2. Sensory receptor 3. Sensory (afferent) neuron 4. CNS integration 5. Efferent (motor) neuron 6. Effector (target tissue) 7. Response (movement)
3. Classified by
  1. Development
    1. Innate reflex
    2. Acquired reflex
  2. Response
    1. Somatic reflex
    2. Visceral reflex
  3. Compexity of circuit
    1. Monosynaptic
    2. Polysynaptic
  4. Processing site
    1. spinal reflex
    2. Cranial reflex
4. Mechanism
5. Strange Reflexes
  1. Babinski reflex
  2. Snout reflex
  3. Glabellar reflex (Myerson's sign)
  4. Palomental reflex
  5. Clonus
Differentials of muscle weakness and wasting
Differentials of Stiffness
1. Traumatic brain injury (TBI)
2. Spinal cord injury
3. Stroke
4. Meningitis
5. Brain damage due to a lack of oxygen
6. Encephalitis
7. Phenylketonuria
Differentials of Numbness
1. PERIPHERAL NEUROPATHY
2. vitamin B1 deficiency and B12 deficiency
3. Multiple sclerosis
4. Stroke
5. Disorders of the brain and spinal cord
  1. Injuries
  2. Tumors
  3. Aneurysm
  4. Infection
  5. Syringomyelia
Difference between neuropathy and myopathy
Neurlogical Examination
1. Dermatomes
2. Neurological Examination Of The Upper Limb
  1. Assesses muscle tone
  2. pronator test
  3. Checks power
  4. Checks deep tendon reflexes: biceps, triceps, supinator, fingers.
  5. Joint position Vibration sense Light touch & pin prick
  6. Coordination assessment
3. Neurological Examination Of The Lower Limb
  1. Assesses gait
  2. muscle tone
  3. Romberg’s test
  4. Checks power
  5. Checks deep tendon reflexes: knee, ankle, planter reflex.
  6. Joint position Vibration sense Light touch & pin prick
  7. Coordination assessment
Normal Gait
1. major criteria essential to walking
  1. Equilibrium
  2. Locomotion
  3. Musculoskeletal Integrity
  4. Neurological Control
2. gait cycle
Pathophysiology of syringomyelia
1. Syrinx acts as intramedullary mass. Redirected CSF fills expanding central canal. Continual movement of CSF builds pressure. Syrinx widens & compresses nerve fibers. Resulting in pain, weakness, and stiffness in back, shoulders, arms, or legs. Each patient experiences a different combination of symptoms depending on where in spinal cord syrinx forms and how far it expands.
Signs and Symptoms of syringomyelia
1. Loss of pain and temperature sensation
2. Muscle wasting and loss of reflexes
3. Ptosis, miosis, and anhidrosis
Investigations
1. MRI
2. Myelogram
Management of syringomyelia
1. Asymptomatic syringomyelia with a small syrinx cavity and with no clear etiology is best managed with watchful waiting and imaging examination.
2. Posterior fossa decompression
3. Percutaneous aspiration of the syrinx
4. Syrinx shunt
5. Resection of the tumor
Chiari malformations
Abnormal gait

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Syringomyelia

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Medienanhänge

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