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102: SYRINGOMYELIA

Mollie Venglar, DSc, MSPT, NCS

CONDITION/DISORDER SYNONYMS

  • Spinal cord cavitation

  • Syringomyelia type III

  • Syrinx

ICD-9-CM CODE1

  • 336.0 Syringomyelia and syringobulbia

ICD-10-CM CODE2

  • G95.0 Syringomyelia and syringobulbia

PREFERRED PRACTICE PATTERN3

  • 5H: Impaired Motor Function, Peripheral Nerve Integrity, and Sensory Integrity Associated with Nonprogressive Disorders of the Spinal Cord

PATIENT PRESENTATION

A 21-year-old male with a 2-year history of C7 quadriplegia reports to his neurologist with report of loss of tenodesis grip and triceps strength bilaterally. Although he is still able to perform his daily functions it is taking longer to do so, and his ability to complete his transfers is becoming more impaired. He denies any injuries or traumas to his spine since the accident that caused the C7 quadriplegia. He has no fever, headache, or nausea. He demonstrates normal cognition. He has not been exposed to any illnesses or viruses, of which he is aware, for several months. MRI reveals a fluid-filled syrinx in the spinal cord at the level of C5.

KEY FEATURES

Description

  • Damage to the spinal cord is caused due to the formation of a fluid-filled cavity within the spinal cord.4

  • The fluid forms a cavity called a syrinx that can elongate over time, destroying the interior of the spinal cord.

Essentials of Diagnosis

  • Four 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

FIGURE 102-1

MRI of syringomyelia associated with a Chiari malformation. Sagittal T1-weighted image through the cervical and upper thoracic spine demonstrates descent of the cerebellar tonsils and vermis below the level of the foramen magnum (black arrows). Within the substance of the cervical and thoracic spinal cord, a CSF collection dilates the central canal (white arrows). (From Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 18th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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General Considerations

  • 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.

Demographics

  • Occurs more often in people with tetra/quadriplegia than in those with paraplegia

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Bowel and bladder dysfunction

  • Hot and cold sensory loss

  • Headaches

  • Pain

  • Paralysis

  • Scoliosis

  • Spreading sensory loss

  • Spreading motor ...

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