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  • Syringomyelia
  • Syrinx
  • Spinal cord cavitation

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  • 336.0 Syringomyelia and syringobulbia

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  • G95.0 Syringomyelia and syringobulbia

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Description

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  • Damage to the spinal cord due to the formation of a fluid filled cavity within the spinal cord

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Essentials of Diagnosis

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  • 4 types of syringomyelia
    • Types I, II, IV are developmental
    • Type III is acquired and associated with one of the following
      • Spinal cord tumor
      • Traumatic myelopathy
      • Spinal arachnoiditis and pachymeningitis
      • Secondary myelomalacia from cord compression, infarction or hematomyelia

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General Considerations

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  • Type III syrinx is suspected when a person with a previously stable presentation experiences changes in sensorimotor function after a spinal cord injury that extends above the level of the original injury.

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Demographics

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Signs and Symptoms

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  • Pain
  • Spreading sensory loss
  • Spreading motor loss
  • Spasticity or involuntary muscle contraction

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Functional Implications

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  • Progressive loss of function until the problem is treated
  • Loss of functional mobility and independence with ADLs

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Possible Contributing Causes

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  • Previous spinal cord trauma is a risk factor
  • Congenital spinal malformations

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Differential Diagnosis

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  • Stenosis
  • Spondylitis
  • Arachnoiditis
  • Meningitis
  • Tangier disease
  • Fabry disease
  • Amyloid polyneuropathy

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Laboratory Tests

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  • Spinal tap via lumbar puncture

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Imaging

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  • MRI
  • CT scan for detailed imaging

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  • Neurologist
  • Neurosurgeon to repair syrinx, restore normal cerebral spinal fluid flow, and relieve pressure on spinal cord
  • Neuro-oncologist
  • Occupational therapist
  • Counselor, psychologist, neuropsychologist

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  • Peripheral nerve integrity
  • Gait
  • Wheelchair mobility
  • Balance
    • Static sit
    • Dynamic sit
    • Static stand
    • Dynamic stand
    • Moving outside the base of support (BOS)
  • Muscle strength
  • Muscle recruitment
  • Coordination
  • Postural control
  • Posture
  • ROM
  • Reflexes
    • Deep tendon reflex (DTR)
    • Babinski
    • Clonus
  • Muscle tone
  • Sensation
  • Bed mobility
  • Transfers
  • Endurance
  • Aerobic capacity
  • Self-care
  • Home management
  • Fine motor
  • Respiratory compromise

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  • American Spinal Injury Association (ASIA) assessment
    • Motor
    • Sensation
    • ASIA classification neurologic level
    • Complete vs. incomplete
    • Functional mobility
      • Functional independence measure (FIMTM)
    • Wheelchair mobility
    • Transfers
    • Gait (timed up and go, 10-meter walk test, functional gait assessment, walking index for spinal cord injury)
  • Sitting and standing (for people with incomplete injuries or damage in the lower lumbar and sacral levels)
  • Balance tests (sitting reach test, Tinetti, Berg balance scale)
    • Cardiovascular and pulmonary endurance (6-minute walk test) if appropriate, upper extremity (UE) ergometer test)
  • Muscle endurance
  • Skin assessment
  • Active and passive ROM, muscle length
  • Posture sitting (wheelchair and edge of mat, supported/unsupported) and standing if applicable
  • Pain

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  • ROM/stretching/positioning
  • Orientation to vertical position if needed: assessing orthostatic hypotension ...

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