Clinical Manifestations of Syringomyelia

        Clinical manifestations of Syringomyelia is highly variable depending on the direction of widening the syrinx, transverse or longitudinal direction. Widening usually occurs towards the anterior of the spinal canal rather than to the right or left. Syringomyelia usually takes place slowly. Course of the disease can be up to many years. Acute symptoms will appear when it is on the brain stem (like syringobulbi).
         Syringomyelia usually occur in the cervical area. Symptoms that appear depend on the location of the lesions. Common symptoms of syringomyelia consist of headache, pain in the shoulders, back , arms and legs, loss of ability to feel hot or cold, especially in the hands, the function of micturition and defecation disorders, and sexual dysfunction. The specific symptoms depend on the location of regional and cross-sectional and pathological processes in the spinal cord.

       Syringomyelia is most often involves the cervical portion and the resulting loss of pain and temperature on the shoulders and arms. If both the anterior horn are damaged, there will be two arms flaccid paralysis associated with atrophy. If the lateral cornua involved, Arm can trophic disorders, may in some degree where the fingers become deformed. Sometimes degenerates and pyramidal tract degeneration may be the cause of spastic paresis of the legs. In most cases, symptoms begin in young adults , and tend to evolve slowly .

Clinical manifestations that occur in syringomyelia as follows :
1. sensory
a. Dissociation of sensory: syrinx will hamper travel spinothalamic tracts that conduct pain and temperature, resulting in the loss of sensation. However excitatory light, vibration and position sense was still good.
b. Dysesthetic pain, is a common symptom in syringomyelia, usually on the neck and shoulders, but can spread to the arms and upper arms. Which sometimes began at an uncomfortable feeling that can lead to this disease. Generally the pain, and illness and can be very severe.

2. motor
a. Syrinx extends into the anterior horn of the spinal cord , damaging the motor neuron (LMN) and diffuse muscle atrophy and starts in the hands and spread proximally on the upper arm and shoulder.
b. Bilateral spastic paralysis can occur on both limbs were accompanied by increased deep tendon reflexes and positive Babinski reflex. Signs of this is due to the further spread of lesions to the lateral, into the white matter that attach to the descending tracts.

3. Autonomous
a. Affect the function of the bowel and bladder are usually late manifestations.
b. Sexual dysfunction may be developed in the case of long
c. Horner's syndrome may appear showing the sympathetic nerve damage, the intermediolateral cell column. Horner's syndrome due to lesions in the brain stem, spinal cord cervical until to spinal cord thoracalis III). Horner's syndrome consists of miosis, ptosis, mild endoftalmus, hemifaciale ipsilateral anhidrosis, elevation of the lower eyelid, ipsilateral hemifaciale hyperemia. Of the six symptom, the most easily recognized is miosis and anhidrosis.

Clinical Syndrome of Syringomyelia based region
       While based on the region, the clinical syndrome of syringomyelia divided by 3, namely: syringobulbi region, region cervicothoracal syringomyelia, and lumbosacral syringomyelia

1. Syringobulbi (bulbar type)
       Symptoms appear usually unilateral, may be deviation of the tongue with hemi atrophy and fibrillation, peripheral paralise n.VII, and paralise n. V (facial analgesia, loss of corneal reflex), paralise n. IX and nX (dysphagia, deviation of the uvula, voice changes) as well as n. XI (weakness and atrophy m.sternocleidomastoideus and m. Trapezius)

2. Syriringomyelia cervicothoracal
        One of the typical symptoms of syringomyelia is a sensory disorder, a dissociative anesthetic that is where the loss of pain and temperature but the sense of touch, vibration and position is still good. The onset of anesthesia is due to the dissociation of the syrinx central conductor damaging fibers pain and temperature (spinothalamicus pathways in the anterior commissure alba). The initial symptoms of this type begins with hand paraesthesia followed by progressive weakness and atrophy of the upper limb and can also be found Horner's syndrome due to damage of fibers ciliospinal on segments C8 - T1. And due to the expansion of the syrinx can damage pyramidal and extrapyramidal pathways that lead paralise extremity spastic type on the bottom. Often acquired neurogenic bladder disorders, disorders of the upper limb tropfik and kyphoscoliosis.

3. Lumbosacral syringomyelia
       This type is rare, clinical symptoms appear is the atrophy of the muscles of the lower leg with loss of pain and temperature also ataau hipalgesik analgesia of the lower extremities, perineum, and genitalia. Tendon reflexes can increase or disappear, depending on whether or not the system intact the motor neurons

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