Syringomyelia

Syringomyelia

1. Anatomy of spinal cord

2. The ventricular system

   • 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.
   • Formation of CSF
     • 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.

3. Ascending & descending tracts

   • Motor Pathway
     • Pyramidal System
       • Corticospinal tract
         • Voluntary, skilled, discrete movements.
         • 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.
         • LMN
           • Anterior horn of the spinal cord
   • Sensory Pathways
     • Posterior white column
     • Posterior (dorsal) spinocerebellar
     • Anterior (ventral) spinocerebellar
     • Lateral Spinothalamic
     • Anterior Spinothalamic

4. Reflexes

   • A reflex is an involuntary and instantaneous movement in response to a stimulus.
   • Components
     • 1. Stimulus 2. Sensory receptor 3. Sensory (afferent) neuron 4. CNS integration 5. Efferent (motor) neuron 6. Effector (target tissue) 7. Response (movement)
   • Classified by
     • Development
       • Innate reflex
       • Acquired reflex
     • Response
       • Somatic reflex
       • Visceral reflex
     • Compexity of circuit
       • Monosynaptic
       • Polysynaptic
     • Processing site
       • spinal reflex
       • Cranial reflex
   • Mechanism
   • Strange Reflexes
     • Babinski reflex
     • Snout reflex
     • Glabellar reflex (Myerson's sign)
     • Palomental reflex
     • Clonus

5. Differentials of muscle weakness and wasting

6. Differentials of Stiffness

   • Traumatic brain injury (TBI)
   • Spinal cord injury
   • Stroke
   • Meningitis
   • Brain damage due to a lack of oxygen
   • Encephalitis
   • Phenylketonuria

7. Differentials of Numbness

   • PERIPHERAL NEUROPATHY
   • vitamin B1 deficiency and B12 deficiency
   • Multiple sclerosis
   • Stroke
   • Disorders of the brain and spinal cord
     • Injuries
     • Tumors
     • Aneurysm
     • Infection
     • Syringomyelia

8. Difference between neuropathy and myopathy

9. Neurlogical Examination

   • Dermatomes
   • Neurological Examination Of The Upper Limb
     • Assesses muscle tone
     • pronator test
     • Checks power
     • Checks deep tendon reflexes: biceps, triceps, supinator, fingers.
     • Joint position Vibration sense Light touch & pin prick
     • Coordination assessment
   • Neurological Examination Of The Lower Limb
     • Assesses gait
     • muscle tone
     • Romberg’s test
     • Checks power
     • Checks deep tendon reflexes: knee, ankle, planter reflex.
     • Joint position Vibration sense Light touch & pin prick
     • Coordination assessment

10. Normal Gait

    • major criteria essential to walking
      • Equilibrium
      • Locomotion
      • Musculoskeletal Integrity
      • Neurological Control
    • gait cycle

11. Pathophysiology of syringomyelia

    • 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.

12. Signs and Symptoms of syringomyelia

    • Loss of pain and temperature sensation
    • Muscle wasting and loss of reflexes
    • Ptosis, miosis, and anhidrosis

13. Investigations

    • MRI
    • Myelogram

14. Management of syringomyelia

    • Asymptomatic syringomyelia with a small syrinx cavity and with no clear etiology is best managed with watchful waiting and imaging examination.
    • Posterior fossa decompression
    • Percutaneous aspiration of the syrinx
    • Syrinx shunt
    • Resection of the tumor

15. Chiari malformations

16. Abnormal gait

Imagens e arquivos do mapa