Monday, May 31, 2010


QUESTION : Which of the following statements about syringomyeliais true?

A. More than half the cases are associated with Chiari malformations.
B. Symptoms typically begin in middle age.
C. Vibration and position sensation are usually diminished.
D. Syrinx cavities are always congenital.


Syringomyelia is a developmental, slowly enlarging cavitary expansion of the cervical cord that produces a progressive myelopathy. Symptoms typically

begin in adolescence or early adulthood. They may undergo spontaneous arrest after several years. More than half are associated with Chiari malformations. Acquired cavitations of the... See More spinal cord are referred to as syrinx cavities. They may result from trauma, myelitis, infection, or tumor. The classic presentation is that of a central cord syndrome with sensory loss of pain and temperature sensation and weakness of the upper extremities. Vibration and position sensation are typically preserved. Muscle wasting in the lower neck, shoulders, arms, and hands with asymmetric or absent reflexes reflects extension of the cavity

to the anterior horns. With progression, spasticity and weakness of the lower extremities and bladder and bowel dysfunction may occur. MRI scans are the diagnostic modality of choice. Surgical therapy is generally unsatisfactory. Syringomyelia associated with Chiari malformations may require extensive decompressions of the posterior fossa. Direct decompression of the cavity is of debatable benefit. Syringomyelia secondary to trauma or infection

is treated with decompression and a drainage procedure, with a shunt often inserted that drains into the subarachnoid space. Although relief may occur, recurrence is common.

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