Posttraumatic Syringomyelia Clinical Presentation

Updated: Sep 02, 2019
  • Author: Lance L Goetz, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
  • Print
Presentation

History

See the list below:

  • 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. [14]

Next:

Physical

See the list below:

  • 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.)

    T2-weighted sagittal image of large, multiloculate T2-weighted sagittal image of large, multiloculated cervical syrinx extending into brainstem. Patient had preserved functional status.
  • 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.

Previous
Next:

Causes

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.

A study by Asan indicated that syringomyelia is a typical later result of a spinal concussion sustained through vertical forces, as based on magnetic resonance imaging (MRI) performed more than 6 months postconcussion. [15]

A study by Yeo et al found that compared with healthy controls, patients with PTS demonstrated significantly lower peak cranial and caudal CSF flow velocities in the spinal subarachnoid space above and below the syrinx, with a significantly shorter caudal flow duration found. The investigators suggested that an association exists between syrinx formation and changes in the CSF flow’s timing. [16]

Previous