Posttraumatic Syringomyelia Clinical Presentation
- Author: Lance L Goetz, MD; Chief Editor: Stephen Kishner, MD, MHA more...
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- Pain is the most commonly reported symptom. Pain may be localized or diffuse and commonly is reported as a dull ache or a burning or stabbing sensation.
- Other symptoms include increased weakness, numbness, increased spasticity, and hyperhidrosis (increased sweating).
- Symptoms often are aggravated by postural change or the effects of the Valsalva maneuver.
- Decreased reflex micturition, progressive orthostasis, autonomic dysreflexia, and relatively painless joint deformity or swelling (Charcot joint) also may be reported. Syringomyelia is the most common cause of Charcot joint in the upper extremity.
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- Spasticity often is increased compared to findings noted in prior examinations. Deep tendon reflex changes (either increased or decreased) may be noted compared with findings from prior examinations.
- Ascending sensory level and sensory dissociation (selective loss of pain and temperature sensation) are very sensitive indicators for detecting progressive PTS. Numbness may involve the face if the syrinx has ascended into the brainstem. (See image below.)
- Progressive weakness and wasting can occur but may be a late finding.
- Other signs may include a complete or partial Horner syndrome or other evidence of dysautonomia (eg, labile blood pressure, hyperhidrosis).
- Signs may be unilateral because ascension of syrinxes often occurs unilaterally.
Traumatic SCI with tethering of the spinal cord to the dura results in impaired CSF circulation. Incomplete spinal canal decompression may predispose the person to tethering and CSF obstruction. These factors are thought to cause syrinx development.
Research supports the concept that chronic mechanical stress to the spinal cord increases the risk for development of syringomyelia. Spinal instrumentation without decompression is also associated with earlier onset of syringomyelia.
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