This document provides an overview of syringomyelia, including:
- It is a spinal cord cavity filled with cerebrospinal fluid, with a prevalence of 9 per 100,000 people.
- It can be caused by traumatic injury, Chiari malformation, or other craniovertebral junction anomalies.
- Symptoms depend on the location and extent of the syrinx and can include sensory loss, weakness, pain, and autonomic dysfunction.
- Magnetic resonance imaging is the best way to diagnose and assess syringomyelia.
- Treatment may involve surgery to decompress the craniovertebral junction, open the syrinx, or place a shunt
This document summarizes the medical history and examination findings of a 16-year-old male patient presenting with occipital headache, neck pain, loss of pain and temperature sensation in the left upper limb, and laxity of the left shoulder joint. Examination revealed loss of sensation from C3 to T2 on the left side and absent biceps and supinator reflexes on the left. MRI showed Arnold-Chiari malformation type 1 with syringomyelia involving the cervical and thoracic spinal cord. The patient was diagnosed with syringomyelia related to Arnold-Chiari malformation.
This document provides an overview of syringomyelia, including its pathogenesis, pathology, classification, clinical features, and natural history. Syringomyelia is a condition characterized by fluid-filled cavities within the spinal cord. It most commonly affects the cervical and thoracic regions. Clinical features include pain and sensory loss. The natural history varies, but symptoms typically progress slowly over years, with some patients experiencing stabilization or spontaneous resolution in rare cases.
Syringomyelia is a condition where a cyst, called a syrinx, develops in the spinal cord. It most commonly affects the lower cervical spine. It is often associated with abnormalities of the skull or spinal column. The majority of cases are linked to Chiari malformation type 1, where the cerebellar tonsils are displaced into the spinal canal. Symptoms vary depending on the location of the syrinx but can include pain, loss of sensation, muscle weakness or atrophy, and autonomic dysfunction. Diagnosis is made using imaging like MRI. Treatment involves surgery to decompress pressure on the spinal cord like laminectomy with the goal of resolving the syrinx.
Transverse myelitis is a rare neurological condition where the spinal cord becomes inflamed across its width. It is often caused by an autoimmune response following a viral infection. Symptoms depend on the level of spinal cord involvement and may include sensory changes, motor weakness, and sphincter disturbances. Diagnosis involves ruling out other causes and showing signs of spinal cord inflammation. The goals of physiotherapy are to improve strength, mobility, and independence through exercises and management of issues like spasticity and skin care.
This document provides information about acute disseminated encephalomyelitis (ADEM). It defines ADEM as a demyelinating disease of the central nervous system that typically presents as a monophasic disorder with encephalopathy and multifocal neurological symptoms. The document discusses the pathogenesis, clinical features, diagnosis, differential diagnosis and treatment of ADEM. It states that ADEM is usually treated initially with high-dose intravenous corticosteroids over 3-5 days.
This document describes Chiari malformation, specifically Chiari type I and II. It discusses the presentation, diagnosis, and treatment of a 34-year-old female patient presenting with progressive arm weakness, shoulder pain, and headaches exacerbated by coughing. Examination found reduced sensitivity in her arms. MRI confirmed Chiari type I malformation with tonsillar herniation. The patient underwent posterior fossa decompression surgery, with improvement in symptoms at 6-month follow up. Chiari malformations cause hindbrain herniation and obstruction of CSF flow, often requiring surgery to enlarge the posterior fossa.
1. Stroke is defined as a nontraumatic brain injury caused by occlusion or rupture of cerebral blood vessels that results in sudden neurological deficits.
2. The most common types of stroke are ischemic (85%) and hemorrhagic (15%). Ischemic strokes are further classified as thrombotic, embolic, or lacunar.
3. Major risk factors for stroke include hypertension, heart disease, diabetes, smoking, and older age. Location of brain injury determines the specific neurological symptoms, such as deficits on one side of the body for middle cerebral artery strokes.
Mononeuritis multiplex is a peripheral neuropathy involving damage to two or more noncontiguous nerves. It can be caused by various systemic conditions like diabetes, vasculitis, infections, and rheumatological disorders. The document discusses the clinical presentation, diagnostic evaluation, management, and treatment of mononeuritis multiplex.
This document summarizes the medical history and examination findings of a 16-year-old male patient presenting with occipital headache, neck pain, loss of pain and temperature sensation in the left upper limb, and laxity of the left shoulder joint. Examination revealed loss of sensation from C3 to T2 on the left side and absent biceps and supinator reflexes on the left. MRI showed Arnold-Chiari malformation type 1 with syringomyelia involving the cervical and thoracic spinal cord. The patient was diagnosed with syringomyelia related to Arnold-Chiari malformation.
This document provides an overview of syringomyelia, including its pathogenesis, pathology, classification, clinical features, and natural history. Syringomyelia is a condition characterized by fluid-filled cavities within the spinal cord. It most commonly affects the cervical and thoracic regions. Clinical features include pain and sensory loss. The natural history varies, but symptoms typically progress slowly over years, with some patients experiencing stabilization or spontaneous resolution in rare cases.
Syringomyelia is a condition where a cyst, called a syrinx, develops in the spinal cord. It most commonly affects the lower cervical spine. It is often associated with abnormalities of the skull or spinal column. The majority of cases are linked to Chiari malformation type 1, where the cerebellar tonsils are displaced into the spinal canal. Symptoms vary depending on the location of the syrinx but can include pain, loss of sensation, muscle weakness or atrophy, and autonomic dysfunction. Diagnosis is made using imaging like MRI. Treatment involves surgery to decompress pressure on the spinal cord like laminectomy with the goal of resolving the syrinx.
Transverse myelitis is a rare neurological condition where the spinal cord becomes inflamed across its width. It is often caused by an autoimmune response following a viral infection. Symptoms depend on the level of spinal cord involvement and may include sensory changes, motor weakness, and sphincter disturbances. Diagnosis involves ruling out other causes and showing signs of spinal cord inflammation. The goals of physiotherapy are to improve strength, mobility, and independence through exercises and management of issues like spasticity and skin care.
This document provides information about acute disseminated encephalomyelitis (ADEM). It defines ADEM as a demyelinating disease of the central nervous system that typically presents as a monophasic disorder with encephalopathy and multifocal neurological symptoms. The document discusses the pathogenesis, clinical features, diagnosis, differential diagnosis and treatment of ADEM. It states that ADEM is usually treated initially with high-dose intravenous corticosteroids over 3-5 days.
This document describes Chiari malformation, specifically Chiari type I and II. It discusses the presentation, diagnosis, and treatment of a 34-year-old female patient presenting with progressive arm weakness, shoulder pain, and headaches exacerbated by coughing. Examination found reduced sensitivity in her arms. MRI confirmed Chiari type I malformation with tonsillar herniation. The patient underwent posterior fossa decompression surgery, with improvement in symptoms at 6-month follow up. Chiari malformations cause hindbrain herniation and obstruction of CSF flow, often requiring surgery to enlarge the posterior fossa.
1. Stroke is defined as a nontraumatic brain injury caused by occlusion or rupture of cerebral blood vessels that results in sudden neurological deficits.
2. The most common types of stroke are ischemic (85%) and hemorrhagic (15%). Ischemic strokes are further classified as thrombotic, embolic, or lacunar.
3. Major risk factors for stroke include hypertension, heart disease, diabetes, smoking, and older age. Location of brain injury determines the specific neurological symptoms, such as deficits on one side of the body for middle cerebral artery strokes.
Mononeuritis multiplex is a peripheral neuropathy involving damage to two or more noncontiguous nerves. It can be caused by various systemic conditions like diabetes, vasculitis, infections, and rheumatological disorders. The document discusses the clinical presentation, diagnostic evaluation, management, and treatment of mononeuritis multiplex.
Peripheral neuropathy is inflammation and degeneration of the peripheral or cranial nerves, impairing conductivity. There are several types including mononeuropathy affecting a single nerve, mononeuropathy multiplex affecting multiple nerves, and polyneuropathy affecting many nerves. Polyneuropathy can have many causes including diabetes, hereditary factors, infections, toxins and metabolic disorders. Symptoms of polyneuropathy include motor weakness, sensory loss like numbness and tingling, and autonomic dysfunction affecting sweating and temperature control. Specific types like diabetic neuropathy and Guillain-Barre syndrome are also discussed. Testing includes nerve conduction studies and electromyography to diagnose peripheral neuropathies.
This document provides an overview of the approach to evaluating and diagnosing ataxia. It defines ataxia and describes how it can be caused by lesions in the cerebellum, posterior column, or vestibular system. It then discusses the clinical features, investigations, and treatment of various causes of ataxia, including cerebellar lesions, hereditary ataxias like Friedreich's ataxia and ataxia telangiectasia, metabolic disorders, and more. The document emphasizes taking a thorough history and examination to identify features that can help determine the underlying cause of ataxia in each patient.
This document discusses various pathologies that can cause damage to the spinal cord as seen on MRI. It focuses on diseases that appear as high signal on T2-weighted imaging. The most common etiologies are degenerative compressive myelopathy, inflammatory disorders, and demyelinating diseases such as multiple sclerosis. Imaging is important for determining the location, extent, and severity of abnormalities in order to accurately diagnose the underlying cause and guide treatment.
This document discusses arachnoiditis, an inflammatory disease of the arachnoid membrane surrounding the spinal cord. It develops in three stages: initial nerve inflammation, scar tissue formation causing nerve adhesion, and complete nerve root encapsulation. Causes include trauma from surgery, chemical exposure, and infection. Symptoms include pain, paresthesia, sensory loss, and muscle weakness. Diagnosis involves MRI or CT myelography. Treatment includes corticosteroids, NSAIDs, rhizotomy for pain, and decompression surgery to remove cysts. Physical therapy techniques like exercises, heat, TENS, and neural mobilization can help manage symptoms.
This document discusses the anatomy, imaging, classification, and treatment of various cervical vertebral anomalies. It begins with an overview of the normal anatomy of the atlantoaxial joint and landmarks seen on imaging. It then discusses various congenital and acquired bony and soft tissue anomalies that can occur in this region, including platybasia, basilar invagination, occipitalization of the atlas, and atlantoaxial dislocation. Imaging criteria and classifications for these conditions are provided. Common associated findings like Chiari malformation and syringomyelia are also mentioned. The document concludes with sections on clinical presentation and evaluation of these cervical vertebral anomalies.
The document discusses acute disseminated encephalomyelitis (ADEM), a rare inflammatory disease of the central nervous system. ADEM is typically triggered by an environmental stimulus in genetically susceptible individuals. It most commonly affects children between 5-8 years old, with symptoms developing within 2 weeks of a viral or bacterial infection in approximately 50-75% of cases. Diagnosis is based on clinical presentation and MRI findings showing multifocal brain inflammation. Treatment involves high-dose corticosteroids, with plasma exchange or IVIG recommended for non-responders. Most children recover fully, but some have residual symptoms like headaches or behavioral issues.
The craniovertebral junction (CVJ) refers collectively to the occiput, atlas, axis, and supporting ligaments. It is a transition zone between the mobile cranium and spinal column, enclosing the soft tissue structures of the cervicomedullary junction. The CVJ has important implications for embryology, anatomy, classification of anomalies, investigations, and clinical management. Anomalies can involve bony, soft tissue, arterial, and neural structures in this region. A variety of imaging modalities like X-rays, CT, MRI are used to classify and characterize CVJ anomalies.
This document provides an overview of stroke syndromes caused by occlusion of arteries in the brain. It describes the classification of strokes as affecting either the anterior or posterior circulation. For anterior circulation strokes, it details the territories supplied and clinical syndromes caused by occlusion of the middle cerebral artery, anterior cerebral artery, and anterior choroidal artery. For posterior circulation strokes, it outlines the arteries involved and syndromes related to vertebral, basilar, and posterior cerebral artery occlusions such as lateral medullary syndrome and lateral pontine syndromes. Diagrams are included to illustrate the vascular anatomy and clinical findings.
Peripheral neuropathy refers to damage to peripheral nerves. There are three main types: mononeuropathy affecting a single nerve, mononeuritis multiplex affecting multiple nerves asymmetrically, and polyneuropathy affecting multiple nerves concurrently and symmetrically. Polyneuropathy can be classified as axonopathy, myelinopathy, or neuronopathy depending on whether the axons, myelin sheaths, or neurons are affected. Symptoms and signs include both negative symptoms like numbness and weakness as well as positive symptoms like tingling and pain. Evaluation involves taking a history and examining for patterns of onset, progression, fluctuations, and other systemic diseases. Diagnosis involves nerve conduction studies and sometimes nerve biopsies. Treatment focuses
Conus Medullaris syndrome (CMS) majorly arises from a spectrum of clinico-pathologic entities representing dysfunction of the lowest level of the spinal cord termed the Conus Medullaris, which consists of the sacral segments. There is a subset of spinal cord injuries clinically referred to as spinal cord injury syndromes, to which Conus Medullaris syndrome belongs, that are grouped by their respective symptomatology, encompassing central cord syndrome [2].
1. The document discusses various causes of myelopathy including infectious, autoimmune, demyelinating, paraneoplastic, metabolic, toxic, and vascular etiologies.
2. Clinical features, imaging, cerebrospinal fluid analysis and differential diagnosis for different types of myelopathies are provided with key distinguishing factors between compressive vs non-compressive, inflammatory vs non-inflammatory myelopathies.
3. Specific conditions like acute transverse myelitis, neuromyelitis optica, HIV myelopathy, syphilitic myelopathy, and acute disseminated encephalomyelitis are summarized in detail.
Chiari malformations are a group of hindbrain abnormalities involving the rhombencephalon and cerebrospinal fluid junction. There are four main types of Chiari malformations described. Chiari type I involves tonsillar herniation below the foramen magnum without brainstem herniation. Chiari type II involves herniation of the brainstem, cerebellar vermis, and fourth ventricle and is associated with myelomeningocele. Chiari type III is an occipital encephalocele with similar anomalies to type II. Chiari type IV involves cerebellar hypoplasia without herniation. Clinical features of Chiari I can include headache, numbness, and
Post polio syndrome is characterized by new muscle weakness, fatigue, and pain in polio survivors decades after their initial bout of polio. It is believed to be caused by overwork of motor neurons that survived the initial poliovirus infection but were left vulnerable. As time passes, these neurons fatigue and can no longer sufficiently innervate muscles. Treatment focuses on managing new symptoms, preserving function through exercise and assistive devices, and addressing pain. Physiotherapy plays a key role through energy conservation techniques, strengthening, and physical modalities like heat.
Damage to spinal cord structures can cause various impairments depending on the location and extent of the lesion. A complete transection of the spinal cord at L1 would cause ipsilateral loss of light touch and proprioception below the lesion, upper motor neuron signs ipsilaterally below, and contralateral loss of pain and temperature sensation. Epiconus syndrome from a lesion at L4-S2 is associated with weakness of hip and knee flexion and ankle movement with sensory loss from L4-S5 and loss of bladder and bowel control. Cutaneous reflexes and other reflexes have localizing value in myelopathy patients.
Human: Thank you for the summary. Can you provide a 3 sentence summary that focuses
Tabes dorsalis is a progressive degeneration of nerve cells and fibers in the spinal cord that carry sensory information to the brain, caused by untreated syphilis. It is characterized by sensory deficits, loss of coordination, and diminished reflexes. The disease progresses through preataxic, ataxic, and paralysis stages. Clinical features include loss of sensation, Argyll Robertson pupils, dementia, hypotonicity, loss of coordination, and trophic ulcers. Treatment involves antibiotics, steroids, pain medications, exercises, and splinting to manage symptoms.
The document discusses the anatomy and neural control of the bladder. It describes the layers of muscle that compose the bladder wall and urethra. Both the internal and external urethral sphincters are discussed as well as their innervation. Five reflex loops or centers are described that coordinate the filling and voiding of the bladder involving brain, spinal cord and peripheral nerves. Different types of neurogenic bladder dysfunction are also summarized based on the level of nervous system lesion.
This document discusses various bony and soft tissue anomalies of the craniocervical junction that can cause compression of the brainstem and spinal cord. It outlines different classification systems and measurement lines used to evaluate these anomalies on imaging. Common anomalies discussed include platybasia, basilar invagination, occipito-atlantal fusion, Arnold-Chiari malformation and syringomyelia. Clinical features and approaches to management are also summarized.
This document provides information on peripheral nerve injuries, including the structure of nerves, classifications of nerve injuries, common sites of injury for specific nerves like the ulnar and radial nerves, clinical features of injuries, and treatment approaches. It details Seddon's and Sunderland's classifications of nerve injuries, which range from neurapraxia to neurotmesis depending on the severity of axonal and neural sheath damage. Specific injuries like ulnar nerve entrapment at the elbow or Guyon's canal are discussed. Both non-surgical and surgical treatment options are presented.
Klippel-Feil syndrome is a congenital condition where two or more cervical vertebrae are fused. It is caused by mutations in genes GDF6 and GDF3 which regulate bone growth. People with Klippel-Feil syndrome have a short neck, limited neck movement, and sometimes scoliosis. Diagnosis involves x-rays and MRIs showing fused vertebrae. Treatment focuses on pain management through medications, physical therapy, and sometimes surgery to correct spinal abnormalities.
chiari or arnold chiari malformations, various types and pathophysiology, radiological and clinical presentation of the types, signs symptoms, investigations and treatment of these malformations both conservative and surgical. considerations and controversiies in management of chiari malformation associated with various conditions.
The document discusses spinal tuberculosis, noting that it causes delays in diagnosis, long recovery periods, and high costs. Key points include:
- Paralysis occurs in up to 50% of spinal tuberculosis patients.
- Early diagnosis, expedient treatment, aggressive surgery, and preventing deformity lead to the best outcomes.
- Diagnosis relies on tests like tuberculin skin tests, imaging like MRI to identify bone destruction and abscesses, and microscopy and culture of samples.
- Patterns of bone involvement include paradiscal, central, anterior, and appendiceal lesions.
- Complications include paralysis, cold abscesses, deformities, and secondary infections.
Peripheral neuropathy is inflammation and degeneration of the peripheral or cranial nerves, impairing conductivity. There are several types including mononeuropathy affecting a single nerve, mononeuropathy multiplex affecting multiple nerves, and polyneuropathy affecting many nerves. Polyneuropathy can have many causes including diabetes, hereditary factors, infections, toxins and metabolic disorders. Symptoms of polyneuropathy include motor weakness, sensory loss like numbness and tingling, and autonomic dysfunction affecting sweating and temperature control. Specific types like diabetic neuropathy and Guillain-Barre syndrome are also discussed. Testing includes nerve conduction studies and electromyography to diagnose peripheral neuropathies.
This document provides an overview of the approach to evaluating and diagnosing ataxia. It defines ataxia and describes how it can be caused by lesions in the cerebellum, posterior column, or vestibular system. It then discusses the clinical features, investigations, and treatment of various causes of ataxia, including cerebellar lesions, hereditary ataxias like Friedreich's ataxia and ataxia telangiectasia, metabolic disorders, and more. The document emphasizes taking a thorough history and examination to identify features that can help determine the underlying cause of ataxia in each patient.
This document discusses various pathologies that can cause damage to the spinal cord as seen on MRI. It focuses on diseases that appear as high signal on T2-weighted imaging. The most common etiologies are degenerative compressive myelopathy, inflammatory disorders, and demyelinating diseases such as multiple sclerosis. Imaging is important for determining the location, extent, and severity of abnormalities in order to accurately diagnose the underlying cause and guide treatment.
This document discusses arachnoiditis, an inflammatory disease of the arachnoid membrane surrounding the spinal cord. It develops in three stages: initial nerve inflammation, scar tissue formation causing nerve adhesion, and complete nerve root encapsulation. Causes include trauma from surgery, chemical exposure, and infection. Symptoms include pain, paresthesia, sensory loss, and muscle weakness. Diagnosis involves MRI or CT myelography. Treatment includes corticosteroids, NSAIDs, rhizotomy for pain, and decompression surgery to remove cysts. Physical therapy techniques like exercises, heat, TENS, and neural mobilization can help manage symptoms.
This document discusses the anatomy, imaging, classification, and treatment of various cervical vertebral anomalies. It begins with an overview of the normal anatomy of the atlantoaxial joint and landmarks seen on imaging. It then discusses various congenital and acquired bony and soft tissue anomalies that can occur in this region, including platybasia, basilar invagination, occipitalization of the atlas, and atlantoaxial dislocation. Imaging criteria and classifications for these conditions are provided. Common associated findings like Chiari malformation and syringomyelia are also mentioned. The document concludes with sections on clinical presentation and evaluation of these cervical vertebral anomalies.
The document discusses acute disseminated encephalomyelitis (ADEM), a rare inflammatory disease of the central nervous system. ADEM is typically triggered by an environmental stimulus in genetically susceptible individuals. It most commonly affects children between 5-8 years old, with symptoms developing within 2 weeks of a viral or bacterial infection in approximately 50-75% of cases. Diagnosis is based on clinical presentation and MRI findings showing multifocal brain inflammation. Treatment involves high-dose corticosteroids, with plasma exchange or IVIG recommended for non-responders. Most children recover fully, but some have residual symptoms like headaches or behavioral issues.
The craniovertebral junction (CVJ) refers collectively to the occiput, atlas, axis, and supporting ligaments. It is a transition zone between the mobile cranium and spinal column, enclosing the soft tissue structures of the cervicomedullary junction. The CVJ has important implications for embryology, anatomy, classification of anomalies, investigations, and clinical management. Anomalies can involve bony, soft tissue, arterial, and neural structures in this region. A variety of imaging modalities like X-rays, CT, MRI are used to classify and characterize CVJ anomalies.
This document provides an overview of stroke syndromes caused by occlusion of arteries in the brain. It describes the classification of strokes as affecting either the anterior or posterior circulation. For anterior circulation strokes, it details the territories supplied and clinical syndromes caused by occlusion of the middle cerebral artery, anterior cerebral artery, and anterior choroidal artery. For posterior circulation strokes, it outlines the arteries involved and syndromes related to vertebral, basilar, and posterior cerebral artery occlusions such as lateral medullary syndrome and lateral pontine syndromes. Diagrams are included to illustrate the vascular anatomy and clinical findings.
Peripheral neuropathy refers to damage to peripheral nerves. There are three main types: mononeuropathy affecting a single nerve, mononeuritis multiplex affecting multiple nerves asymmetrically, and polyneuropathy affecting multiple nerves concurrently and symmetrically. Polyneuropathy can be classified as axonopathy, myelinopathy, or neuronopathy depending on whether the axons, myelin sheaths, or neurons are affected. Symptoms and signs include both negative symptoms like numbness and weakness as well as positive symptoms like tingling and pain. Evaluation involves taking a history and examining for patterns of onset, progression, fluctuations, and other systemic diseases. Diagnosis involves nerve conduction studies and sometimes nerve biopsies. Treatment focuses
Conus Medullaris syndrome (CMS) majorly arises from a spectrum of clinico-pathologic entities representing dysfunction of the lowest level of the spinal cord termed the Conus Medullaris, which consists of the sacral segments. There is a subset of spinal cord injuries clinically referred to as spinal cord injury syndromes, to which Conus Medullaris syndrome belongs, that are grouped by their respective symptomatology, encompassing central cord syndrome [2].
1. The document discusses various causes of myelopathy including infectious, autoimmune, demyelinating, paraneoplastic, metabolic, toxic, and vascular etiologies.
2. Clinical features, imaging, cerebrospinal fluid analysis and differential diagnosis for different types of myelopathies are provided with key distinguishing factors between compressive vs non-compressive, inflammatory vs non-inflammatory myelopathies.
3. Specific conditions like acute transverse myelitis, neuromyelitis optica, HIV myelopathy, syphilitic myelopathy, and acute disseminated encephalomyelitis are summarized in detail.
Chiari malformations are a group of hindbrain abnormalities involving the rhombencephalon and cerebrospinal fluid junction. There are four main types of Chiari malformations described. Chiari type I involves tonsillar herniation below the foramen magnum without brainstem herniation. Chiari type II involves herniation of the brainstem, cerebellar vermis, and fourth ventricle and is associated with myelomeningocele. Chiari type III is an occipital encephalocele with similar anomalies to type II. Chiari type IV involves cerebellar hypoplasia without herniation. Clinical features of Chiari I can include headache, numbness, and
Post polio syndrome is characterized by new muscle weakness, fatigue, and pain in polio survivors decades after their initial bout of polio. It is believed to be caused by overwork of motor neurons that survived the initial poliovirus infection but were left vulnerable. As time passes, these neurons fatigue and can no longer sufficiently innervate muscles. Treatment focuses on managing new symptoms, preserving function through exercise and assistive devices, and addressing pain. Physiotherapy plays a key role through energy conservation techniques, strengthening, and physical modalities like heat.
Damage to spinal cord structures can cause various impairments depending on the location and extent of the lesion. A complete transection of the spinal cord at L1 would cause ipsilateral loss of light touch and proprioception below the lesion, upper motor neuron signs ipsilaterally below, and contralateral loss of pain and temperature sensation. Epiconus syndrome from a lesion at L4-S2 is associated with weakness of hip and knee flexion and ankle movement with sensory loss from L4-S5 and loss of bladder and bowel control. Cutaneous reflexes and other reflexes have localizing value in myelopathy patients.
Human: Thank you for the summary. Can you provide a 3 sentence summary that focuses
Tabes dorsalis is a progressive degeneration of nerve cells and fibers in the spinal cord that carry sensory information to the brain, caused by untreated syphilis. It is characterized by sensory deficits, loss of coordination, and diminished reflexes. The disease progresses through preataxic, ataxic, and paralysis stages. Clinical features include loss of sensation, Argyll Robertson pupils, dementia, hypotonicity, loss of coordination, and trophic ulcers. Treatment involves antibiotics, steroids, pain medications, exercises, and splinting to manage symptoms.
The document discusses the anatomy and neural control of the bladder. It describes the layers of muscle that compose the bladder wall and urethra. Both the internal and external urethral sphincters are discussed as well as their innervation. Five reflex loops or centers are described that coordinate the filling and voiding of the bladder involving brain, spinal cord and peripheral nerves. Different types of neurogenic bladder dysfunction are also summarized based on the level of nervous system lesion.
This document discusses various bony and soft tissue anomalies of the craniocervical junction that can cause compression of the brainstem and spinal cord. It outlines different classification systems and measurement lines used to evaluate these anomalies on imaging. Common anomalies discussed include platybasia, basilar invagination, occipito-atlantal fusion, Arnold-Chiari malformation and syringomyelia. Clinical features and approaches to management are also summarized.
This document provides information on peripheral nerve injuries, including the structure of nerves, classifications of nerve injuries, common sites of injury for specific nerves like the ulnar and radial nerves, clinical features of injuries, and treatment approaches. It details Seddon's and Sunderland's classifications of nerve injuries, which range from neurapraxia to neurotmesis depending on the severity of axonal and neural sheath damage. Specific injuries like ulnar nerve entrapment at the elbow or Guyon's canal are discussed. Both non-surgical and surgical treatment options are presented.
Klippel-Feil syndrome is a congenital condition where two or more cervical vertebrae are fused. It is caused by mutations in genes GDF6 and GDF3 which regulate bone growth. People with Klippel-Feil syndrome have a short neck, limited neck movement, and sometimes scoliosis. Diagnosis involves x-rays and MRIs showing fused vertebrae. Treatment focuses on pain management through medications, physical therapy, and sometimes surgery to correct spinal abnormalities.
chiari or arnold chiari malformations, various types and pathophysiology, radiological and clinical presentation of the types, signs symptoms, investigations and treatment of these malformations both conservative and surgical. considerations and controversiies in management of chiari malformation associated with various conditions.
The document discusses spinal tuberculosis, noting that it causes delays in diagnosis, long recovery periods, and high costs. Key points include:
- Paralysis occurs in up to 50% of spinal tuberculosis patients.
- Early diagnosis, expedient treatment, aggressive surgery, and preventing deformity lead to the best outcomes.
- Diagnosis relies on tests like tuberculin skin tests, imaging like MRI to identify bone destruction and abscesses, and microscopy and culture of samples.
- Patterns of bone involvement include paradiscal, central, anterior, and appendiceal lesions.
- Complications include paralysis, cold abscesses, deformities, and secondary infections.
This document provides information on vestibular schwannoma (VS), including:
- VS arises from schwann cells surrounding the vestibular nerve in the internal acoustic meatus.
- It is a benign, slow-growing tumor that initially causes hearing loss and tinnitus. As it expands, it can compress cranial nerves and cause symptoms like facial numbness.
- Diagnosis involves hearing tests showing asymmetric hearing loss and imaging like MRI showing a globular mass.
- Treatment depends on tumor size and hearing status. Surgery options include translabyrinthine, middle fossa, and retrosigmoid approaches.
Imaging of spinal cord acute myelopathiesNavni Garg
This presentation provides a comprehensive review of imaging of causes of acute myelopathies and a systemic approach for narrowing down the differentials
This document discusses various types of birth injuries including:
- Head and neck injuries such as caput succedaneum, cephalhematoma, subgaleal hemorrhage, skull fractures, and intracranial hemorrhages.
- Nerve injuries including brachial plexus injuries (Erb's palsy and Klumpke's palsy) and facial nerve palsy.
- Risk factors for birth injuries include prolonged or difficult labor, fetal macrosomia, and instrument-assisted delivery. Birth injuries can cause impairments ranging from mild swelling to life-threatening hemorrhages requiring medical or surgical intervention.
The document discusses craniovertebral junction anomalies including definitions, classifications of bony and soft tissue anomalies, Arnold-Chiari malformation types, clinical presentations, investigations, and treatments. Major anomalies discussed include platybasia, occipitalization, basilar invagination, dense dysplasia, atlanto-axial disease, Arnold-Chiari malformations, syringomyelia, and syringobulbia. Clinical features, investigations using MRI/CT, and surgical treatments are described for various conditions.
This document discusses various types of birth injuries including definitions, risk factors, and descriptions of specific injuries such as head and neck injuries, fractures, and nerve damage. It provides details on different types of extracranial head injuries (caput succedaneum, cephalhematoma, subgaleal hemorrhage), cranial injuries (linear skull fractures, depressed skull fractures), and various forms of intracranial hemorrhage. Signs, symptoms, risk factors, diagnosis, and management are described for each injury. Brachial plexus injuries including Erb's palsy and Klumpke's palsy as well as facial nerve palsy are also summarized.
CLINICAL FEATURES, INVESTIGATIONS AND PROGNOSIS OF BRAIN SEMINAR 2.pptxcheshtasharma22
This document provides information on brain tumors, including their anatomy, classification, clinical features, investigations, and prognosis. It discusses the various types of primary and secondary brain tumors, how they present depending on their location in the brain, common signs and symptoms like headaches and seizures. Investigations covered include neuroimaging techniques like MRI, CT, PET scans which are used to diagnose and characterize brain tumors. Prognosis depends on tumor type, grade, size and location.
This document discusses birth injuries, including definitions, risk factors, types, and descriptions of specific injuries. Some key points:
- Birth injuries occur in about 0.7% of births and account for under 2% of neonatal deaths. Factors like difficult delivery or fetal positioning can increase risk.
- Types of injuries include head/neck trauma, nerve injuries, fractures, and internal organ damage. Specific injuries discussed include brachial plexus injuries, skull fractures, intracranial hemorrhages, and others.
- Injuries are described in detail, along with typical presentations, diagnostic methods, and treatment approaches depending on severity. Head injuries commonly involve skull fractures or bleeding, while nerve injuries often affect the
Cerebellopontine Angle Tumor can arise from various structures in the CPA. Vestibular schwannoma, also known as acoustic neuroma, is the most common type and arises from the vestibulocochlear nerve. Patients present with hearing loss, tinnitus, and imbalance. MRI is the preferred imaging method and shows a well-defined enhancing mass. Treatment options include observation, surgery to remove the tumor, and stereotactic radiosurgery.
Lytic lesions of the skull can have many potential etiologies ranging from normal variants to neoplastic lesions. Imaging plays an important role in the evaluation and diagnosis of lytic skull lesions. CT and MRI are often used to characterize the lesions and assess bone and soft tissue involvement. The differential diagnosis depends on factors like the patient's age, lesion characteristics such as appearance, location and whether it is solitary or multiple. Common etiologies include metastases, multiple myeloma, epidermoid cysts, hemangioma and fibrous dysplasia among others. A thorough clinical history and imaging findings are needed to establish the correct diagnosis.
This document discusses various neuro-oncological emergencies that may arise in cancer patients involving the brain or spinal cord. It outlines the clinical diagnosis and emergency management of conditions like increased intracranial pressure from brain tumours, hydrocephalus, new onset seizures, pituitary apoplexy, and spinal cord compression. The key steps in emergency management include initiation of steroids, CSF diversion procedures if needed, and potential for tumour resection if symptoms cannot be controlled otherwise. Timely recognition and treatment is important to prevent neurological deterioration in these neuro-oncological emergencies.
This document discusses various malformations of the posterior fossa, including Chiari malformations, Dandy-Walker malformation, Joubert syndrome, and Rhomboencephalosynapsis. It provides details on the anatomy and development of the posterior fossa. Chiari type 1 malformation is described as the most common, characterized by caudal descent of the cerebellar tonsils through the foramen magnum. Chiari type 2 malformation is associated with myelomeningocele and involves descent of the brainstem into the spinal canal through an abnormally small posterior fossa. Imaging and treatment options are discussed for evaluating and managing these posterior fossa malformations.
A 35-year-old man presented to the emergency department with neck pain, dizziness and confusion after yanking a fishing rod the previous day. Imaging revealed a left internal carotid artery dissection with an ischemic stroke in the left frontal region. He was started on dual antiplatelet therapy and speech therapy. A follow up after 3 months showed modified Rankin score of 0-1, indicating minimal or no symptoms. Cervico-cephalic artery dissections occur when there is a tear in the artery wall, allowing blood to dissect into the wall and cause a hematoma. They typically present with neck pain, headaches, strokes, or Horner's syndrome. Diagnosis is made using CTA, MRA
Carpal tunnel syndrome is compression of the median nerve at the wrist, causing numbness and tingling in the hand and fingers. It is typically diagnosed based on symptoms and physical exam findings. Conservative treatment includes splinting, corticosteroid injections, and lifestyle changes. If conservative treatment fails, surgical release of the transverse carpal ligament is performed, either via open or endoscopic technique. Care must be taken during surgery to avoid injuring nearby structures like nerves and blood vessels.
Chiari malformations are a group of hindbrain malformations where brain tissue herniates through the foramen magnum. Chiari type I is the most common, characterized by cerebellar tonsil herniation of >5mm through the foramen magnum. Patients may be asymptomatic or experience headaches, neck pain, or syringomyelia. Treatment involves decompression surgery. Chiari type II involves brainstem herniation and is associated with myelomeningocele. It causes a small posterior fossa and "banana-shaped" cerebellum. Chiari type III is an encephalocele of the posterior fossa contents through the foramen magnum.
1. Spinal cord injuries and diseases can be traumatic due to external forces or non-traumatic due to underlying conditions. Common non-traumatic diseases include tumors, infections, inflammation, and vascular abnormalities.
2. Assessment involves evaluating neurological function, imaging like MRI to identify abnormalities, and diagnostic tests like lumbar puncture. Management depends on the specific condition but may require surgery, antibiotics, steroids, or other treatments.
3. Outcomes depend on the level and completeness of injury, with earlier treatment often leading to better recovery of function. Quality of life is significantly impacted due to paralysis and other functional limitations.
This document discusses craniovertebral anomalies and Arnold-Chiari malformations. It begins by defining the craniocervical junction and some common anomalies seen in India, like atlantoaxial dislocation. Diagnosis involves radiological lines and angles used to identify abnormalities. Chiari malformations are described as hindbrain herniations causing compression. Type I is most common and can cause symptoms through cord/medulla compression, cerebellar compression, and disrupted CSF flow. MRI is key for diagnosis. Management may involve conservative treatment or decompression surgery.
The document provides an overview of imaging of skull base lesions. It discusses the normal skull base anatomy and bones that make up the skull base. It then covers lesions that can arise in the anterior, middle, and posterior skull base, including meningiomas, chordomas, glomus jugulare tumors, and metastases. Imaging findings for different lesions on CT and MRI are presented. The document serves as a pictorial review of common and uncommon skull base lesions.
This document provides information on vestibular schwannoma (VS), a tumor that originates from Schwann cells in the vestibular nerve. It discusses the anatomy of the cerebellopontine angle and internal acoustic meatus where VS typically develops. The epidemiology, classification, pathology, natural history, clinical features, diagnosis and management of VS are described. Two common surgical approaches for removing VS are discussed in detail: the translabyrinthine approach and retrosigmoid approach. Both aim to fully resect the tumor while preserving facial nerve function.
The basal ganglia are a group of subcortical nuclei located at the base of the forebrain that help control posture and voluntary movement. They include the striatum (caudate nucleus and putamen), globus pallidus, substantia nigra, and subthalamic nucleus. The basal ganglia have direct and indirect pathways that use GABA and glutamate to influence motor, cognitive, and emotional functions through closed loops with the cortex and thalamus.
1. CNS tuberculosis is caused by Mycobacterium tuberculosis and can manifest as tuberculous meningitis, tuberculomas, or tuberculous brain abscesses.
2. It spreads hematogenously from a primary pulmonary infection and the bacilli can infect microglial cells in the brain.
3. Clinical features include fever, headache, meningismus, seizures, and focal neurological deficits that vary depending on the location and size of lesions in the brain or meninges.
This document discusses CSF rhinorrhea (leakage of cerebrospinal fluid from the nose). It classifies CSF fistulas as either traumatic (often post-procedure) or non-traumatic. It describes the routes of CSF egress from different skull fracture patterns and surgical sites. Clinical features, investigations for locating the fistula, and management approaches including conservative care, timing of surgery, types of repair, and endoscopic techniques are outlined. The goal of treatment is to prevent serious complications like meningitis by achieving definitive repair of the CSF leak.
Whiplash is an injury to the neck caused by sudden acceleration-deceleration movements like those seen in car accidents. It can cause neck pain and stiffness as well as headaches. While imaging may appear normal, whiplash can still cause soft tissue damage to neck muscles, ligaments, and discs. Symptoms can last over a year in many cases. Treatment focuses on pain relief, muscle relaxation, and in severe cases surgery may be needed. Prognosis is often worse for those with multiple injuries, females, and older individuals.
Phenytoin is an anticonvulsant drug effective against partial and tonic-clonic seizures. It was first synthesized in 1908 but its anticonvulsant properties were not discovered until 1938. Phenytoin works by slowing the recovery of voltage-gated sodium channels from inactivation, limiting repetitive neuronal firing. Its effects are concentration-dependent and it has a narrow therapeutic index. Phenytoin is extensively bound to serum proteins and has nonlinear pharmacokinetics, making dosage adjustments complex. It can interact with many other drugs through effects on hepatic cytochrome P450 enzymes.
This document provides an overview of varicose veins, including their anatomy, risk factors, classification, clinical presentation, and treatment options. Key points include:
- Varicose veins are dilated, tortuous veins caused by faulty valves that allow blood to flow backwards. The long and short saphenous veins are most commonly affected.
- Risk factors include heredity, prolonged standing, obesity, pregnancy, and prior deep vein thrombosis. Varicose veins affect 35% of the population, with severe cases in 10% and chronic venous insufficiency in 8%.
- Treatment options include ligation and stripping, ligation of incompetent perforators, sclerotherapy, endovenous laser ablation
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
3. INTRODUCTION
• ‘Tubular cavitations’ of spinal cord filled with
CSF
• Prevalence – 9/1,00,000 people
• Incidence -0.44 cases/year
• Etiology – Traumatic , CVJ anomaly
• Prognosis and response to surgery – Depends
on Basic pathophysiology
• Associated with chiari I malformation in 60%-
70% of patients
4. • Hydromyelia – Simon – lined by ependymal
cells – Dilatation of central canal
• Classical Syringomyelia – Lined by glial tissue
• Hydrosyringomyelia – More accurate
5.
6. CLASSIFICATIONS
• Barnet et al – Communicating and non-
communicating
• Milhort et al- Communicating , non-
communicating , Atrophic
• Batzdorf et al- a) associated with CVJ anomaly
• b) abnormalities at spinal level
8. Aetiology
• A) Abnormalities at CVJ
• Bony abnormalities- Basilar
invagination,Platybasia,Bone tumours
• Arachnoid scarring- Trauma, infection, inflammation
• Subarachnoid space compression- Hind brain
impaction- Chiari I malformation
• Fourth ventricular cyst- Dandy walker malformation,
Tumours- Extrinsic and intrinsic
9.
10. • B) Abnormalities at spinal level
• Arachnoid scarring- Trauma, surgery,
infection, inflammation
• Subarachnoid space -Tumours- Extrinsic and
intrinsic, spondylosis
11. • Traumatic syrinx- More common in thoracic
spine- develops in the vicinity of spinal cord
injury
• Myelomeningocele –Chiari II malformation-
Cervical and thoracic syrinx
• Close D/d – intramedullary spinal cord cyst –
protein rich cyst fluid generated by neoplasm
itself
12.
13. Mechanism of syrinx formation
A)Associated with CVJ anomaly
• Nearly 60% associated in Chiari I malformation
• Chiari I cerebellar tonsillar herniation
• Chiari II malformation- tonsillar herniation,
buckling of medulla,beaking of tectum, large
massa intermedia, hydrocephalus -
meningocele
14. • Gardner - Hydrodynamic theory- high pressure
waves from the fourth ventricle passing
through the opening at the rostral end of the
central canal produced progressive
enlargement of the fluid collection
• the fluid entering the spinal cord parenchyma,
driven by the arterial pulsations, would
coalesce and rupture into and therefore
enlarge the central canal
15. • Milhorat --> CSF was continually produced by
the ependymal cells lining the central canal -->
the expansion of the central canal occurred in
segments isolated by occlusion or stenosis at
each end, such as occurs with viral
ependymitis
16. • Ball and Dayan
• CSF fluid dissects into the spinal cord
parenchyma along the Virchow Robin space,
when tonsillar impaction prevented the
upward escape of CSF
17. Syringomyelia Related to Primary
Spinal Abnormalities
• the necrotic tissue and the haematoma within
the injured spinal cord --> resorbed and
replaced by a cystic cavity
• “spinal-spinal pressure dissociation” model -->
Rapid pressure equilibrium in the
subarachnoid space proximal and distal to the
scar --> the CSF to move into the lower
pressure environment of the central canal
region of the spinal cord.
18. • a syrinx like lesion can develop, following
atrophy of the swollen spinal cord which has
undergone demyelination.
• The predilection of inflammatory lesions of
the spinal cord to produce secondary necrosis
and subsequently syrinx may be a
consequence of the tight investment of the
cord by pia.
19. Mechanism of Syrinx Propagation
• Gardner - Hydrodynmic theory - driven by the
arterial pulsations, would coalesce and
rupture into and therefore enlarge the central
canal- With Cine gated MRI - Obselete
20. • Williams - normal physiologic events, such as
coughing and straining -- > the pressure
differentials initiated by epidural venous
distension --> to and fro fluid dissection within
the spinal cord referred to as slosh.
Oldfield --> systolic pressure wave of the
subarachnoid CSF applied against the surface
of the spinal cord --> forces the syrinx fluid to
move caudally within the cyst
21. SYMPTOMATOLOGY
• Most patients with hind brain anomaly related
syringomyelia become symptomatic in young
adulthood.
• The mean age at onset of symptoms was third
decade
• more common in males.
22.
23. • progresses slowly and the course may extend
over many years
• a more acute course, especially when the
brainstem is affected
Syringomyelia usually involves the cervical area.
24. • The majority of cases of syringomyelia are
associated with Chiari malformation.
• Therefore, it is essential to differentiate
symptoms predominantly due to central spinal
cord cavitations from those due to hindbrain
descent.
25. Symptoms Predominantly Due to
Central Spinal Cord Cavitation
• dissociated sensory loss, amyotrophy and
spastic paraparesis
• Initially Unilateral - later stages, with a larger
syrinx, the symptoms may become bilateral
• Dissociated sensory deficit is due to damage
of the spinothalamic fibres (conveying pain
and temperature sensation) in the anterior
commissure.
26.
27. • The ascending sensory fibres involved with
light touch and proprioception are usually
spared.
• The anterior commissure is damaged at the
levels of the syrinx but remains intact rostrally
and caudally.
• The resulting sensory deficit has been
described as “cape like” or as a “suspended
sensory level of cuirasse” because it typically
involves the breast-plate distribution.
28.
29. • Posterior column involvement --> position and
vibration sense lost, astereognosis
• Amyotrophy of the muscles --> damage of the
anterior horn cells --> usually begins in the
hands and extends into the proximal upper
extremities.
30. • Lower extremity motor symptoms --> destruction or
compression of the corticospinal tracts in the lateral
columns --> asymmetric spastic paraparesis with
absent superficial reflexes, increased deep tendon
reflexes and extensor plantar responses.
• Respiratory insufficiency --> related to changes in
posture,may occur.
• Sphincter disturbance may occur as a late finding.
31. • Complex regional pain syndrome(CRPS) --> reflex
sympathetic dystrophy --> oedema, changes in skin
blood flow, abnormal pseudomotor activity in the
region of the pain, and allodynia or hyperalgesia ->
Usually in Distal aspect of an affected extremity.
• If the syrinx extends into the medulla, syringobulbia
develops, with symmetric limb weakness, palatal
weakness, wasting of the tongue, dissociated
trigeminal sensory loss and nystagmus.
32. Lower cranial nerve signs and symptoms are seen
particularly with basilar invagination --> the syrinx
cavity can extend beyond the medulla in the
brainstem into the centrum semiovale
(syringocephalus).
Clinical symptoms associated with Chiari malformation
include headache, neck pain, cerebellar dysfunction,
nystagmus, spasticity,ataxia, diplopia and bulbar
palsies (dysphagia).
These symptoms tend to develop in adolescence and
early adulthood
33. IMAGING
• Magnetic resonance imaging is the best
imaging modality for diagnosis of
syringomyelia
• demonstrate the extent of syrinx along with
associated soft tissue abnormalities of the
craniovertebral junction, neoplasms, stenosis
and arachnoid scarring.
34.
35. • Imaging of the entire rostrocaudal extension
of the cyst or cysts is important.
• It also helps to see the flow and septations
inside the syrinx.
• Gadolinium enhanced images are indicated if
a tumour is suspected
• Magnetic resonance angiography may be
helpful in cases of syringomyelia associated
with vascular lesions.
36. • Myelography with delayed CT performed after 4–12
hours may be used in patients who are unable to
tolerate MRI and may demonstrate contrast
accumulation in the cyst.
• Cardiac gated cine mode T2 weighted MRI has been
used to demonstrate CSF flow patterns less
pulsatile flow within the syrinx is associated with a
decreased likelihood of benefit from surgery.
37. • Real-time ultrasonography is rarely used for
imaging syringomyelia. It is technically more
feasible in young children or in thin patients.
• Routine radiographs may demonstrate a
widened cervical canal, bony abnormalities of
the skull and CV junction, platybasia, midline
keel and assimilation of the atlas
38. • The natural history of syringomyelia varies from
spontaneous and complete regression to progressive
devastating neurologic deficits.
• Lord Brain described it, “relentlessly progressive”.
• The possibility that a syrinx may spontaneously
disappear may warrant a more conservative
approach in certain instances.
• Patients with a nearly normal sized spinal cord --> a
benign clinical course
• if significant spinal cord dilation was seen --> the
symptoms tended to progress.
40. SELECTION OF PATIENTS FOR
SURGERY
• Progressive neurological deficits
• Sequential images show progressive
enlargement of syringomyelia
• Patients with little or no neurological deficits
should be followed up with serial neurological
examination
41. • Radiological syrinx grading assessed by
cyst:cord and cord:canal ratios
• Lack of correlation between the clinical and
radiological grades pre as well as
postoperatively
• Radiological reduction in the size of syrinx far
outweighed clinical improvement
• Prognosis depends on clinical grading more
than radiological grading
42. • Main goal of surgery is to arrest progression of
neurological deficits
• Suboccipital headache- tonsillar impaction –
responds to PF decompression
• Pyramidal tracts signs and spinothalamic
sensory loss – Pressure of cyst on these tracts
get reduced
• Weakness and atrophy of hands – destruction
of anterior horn cells- doesn’t improve
43. • Dysesthetic pain – Poorly respond with
surgery
• Lower cranial nerves – Brain stem symptoms –
Candidates of surgery
44. Surgical management of Syringomyelia
associated with CVJ anomaly
• Symptomatic patients are treated surgically
• Top down rule
• Hydrocephalus – VP shunt
• Suboccipital decompressive craniectomy +/-
Cervical laminectomy +/- Expansive duraplasty
• Dural opening – Controversial
• Dural bands – freed
• Arachnoid adhesions release, manipulation of
tonsils - Controversial
45. • A tube or sialastic wick placed in the midline
in the fourth ventricle outlet.
• Fourth ventricle to subarachnoid shunting
• Plugging of obex, excision of tonsils –
controversial , not recommended now a days
• If no neurological improvement after 3-6
months – Syringoperitoneal shunt may be
suggested
46.
47. Surgical management of Syringomyelia
associated with Primary spinal abnormality
• Syringostomy
• Shunting – Syrinx to Subarachnoid space,
Pleural and peritoneal space
• Endoscopic release of septations
48. • Syringostomy – Oldest surgical site
• Laminectomy at appropriate site dorsal
longitudinal incision through the thinned out
spinal cord spinal cord incisions are made
in to midline or just posterior to dorsal root
entry zone
• Myringostomy tube may be inserted –
Ventureyra et al
49. • Aschoff and Kunze et al – 41% improvement
• 25% stabilisation
• 36% deterioration
50. Shunting procedure
• Exposing spinal cord at max diameter of syrinx
by laminectomy or hemilaminectomy Small
myelotomy done at midline or near dorsal
root entry zone proximal catheter may be
inserted caudal or cephalad
• Distal end tunneled in to subarachnoid space
or pleural space or peritoneal space
53. • Increase CSF flow – open and endoscopic
dissection of subarachnoid dissections-
expansile duraplasty – tacking of dura
54. • Abe et al
• Type I – Syringomyelia Associted with Chiari –
Posterior fossa decompression
• Type II- Ass. With Basal arachnoiditis –
Cisterna magna narrowed by scar tissue -
Posterior fossa decompression – Fouth
ventriculo subarachnoid shunt
55. • Type III –Syringomyelia communicating with
fourth ventricle with hydrocephalus – Posterior
fossa decompression, dissection of dural band
obstructing foramen of Magendie+ /- plugging
of obex
56. • Type IV – Arachnoid scarring around spinal
cord with normal CVJ –
• If localised – Syringosubarachnoid shunt
• If Not localised – Syringoperitonel shunt
• Type V – No associated anomalies-
Syringosubarachnoid shunt or
lumboperitoneal shunt
57. OUTCOME OF SURGERY
• Pain – 81.5 %improved , 7.4% worsened ;
11.1% - stabilised
• Motor strength – 70 % improved , normal in
21 % , worsened in 6 %, Unchanged – 3%
• Sensation – improved 6% ; unchanged 61%;
normal -29% , worsened in 4%
58. Surgical failure and complications
• Cerebellar ptosis – Large craniectomy
• Tethering and scarring of cervical spinal cord
• Recurrent syringomyelia
• Instability of CVJ
• Regeneration of foramen magnum
• Psuedomeningocele
59. • Shunting procedure- kinking of tube, displaced
• Blockage internally – arachnoid scar,
proteinaceous fluid, tissue debris
• Overdrainage of CSF – Hind brain herniation
• Cardiopulmonary arrest
• CSF leak and fatal infection
• Recurrence of cyst