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SYRINGOMYELIA

Definition Pathology: Cavitation & gliosis Location Spinal cord: Usually cervical or thoracic Medulla Course: Chronic Clinical syndrome Epidemiology Onset: Most commonly between ages 25 to 40 Males somewhat > females Clinical features: Variable depending on anatomical involvement Anterior horns Weakness & wasting: Especially in hands & arms Fasciculations Posterior horns & decussating sensory fibers Loss of pain & temperature sensation Distribution: Usually "suspended" Involving arms & trunk Sparing legs Pain: Occasional; Boring or lancinating Large fiber sensations: Usually preserved Autonomic pathways Horner's syndrome Skin: Trophic changes Neurogenic bladder Corticospinal tracts: Variable involvement Spastic paraparesis: Legs > arms Other Scoliosis Tendon reflexes: Reduced or absent in arms Cranial nerve involvement: With syringobulbia Most often unilateral XII: Tongue weakness & hemiatrophy IX - X: Dysphagia; Dysarthria XI: Weakness & wasting of sternomastoid & trapezius VII: Facial paresis Descending tract of V: Reduced pain & temperature on lateral face "Onion skin" distribution Reduced corneal sensation & reflex Course: Very slow progression Radiology: A; B Associated disorders Spina bifida (10%) ? cervical rib Arnold-Chiari malformation Familial syringomyelia Prior trauma or hematomyelia Spinal cord gliomas