Pathophysiology of Syringomyelia

Pathophysiology of syringomyelia is not widely known and most commonly used theory is the theory of Gardne , William and Oldfield .

Gardner's Hydrodinamic Theory
        This theory suggests that syringomyelia is the result of a "water hammer" - like pulsatile transmission of Cerebrospinal Fluid ( SF) pressure, through a connection between the fourth ventricle and spinal canal centralis . Blockade originated from the foramen of Magendie.

William Theory
        This theory states that the development of a syrinx, particularly in patients with Chiari malformation, following the pressure difference between the intracranial spinal, which is caused by the action, eg valves in the foramen magnum.  Increased pressure from increased venous subarachnoid fluid during coughing or Valsalva maneuver is localized to the intracranial compartment.

        Malformations of the brain behind preventing an increase in pressure. During Valsalva, increasing pressure on the cisterna magna simultaneously accompanied by a progressive decline in subarachnoid pressure. Craniospinal pressure gradient illustrates the charging CSF into the syrinx .

Oldfield Theory
        The movement of the cerebellar tonsils downward, during systole, can be observed with dynamic MRI. This wobble causes the piston effect on the spinal cord subarachnoid layer, it affects the surface of the spinal cord and CSF forcing passes between perivascular and interstitial space, making the syrinx intrameduler pressure increases . Signs and symptoms of neurologic dysfunction arises due to distension of the syrinx resulting in compression along the tract and neurons and microcirculation. Symptoms that appear comparable to the increase in pressure that would intrameduler recovered by means of decompression .

Intramedullary Pulse Pressure Theory
             This theory explains that syringomyelia is caused by an increase in the pulsatile spinal cord, and the presence of a syrinx which contains extracellular fluid. The new principle is applied that the formation of syringomyelia trying to do with the increase in pulsatile pressure on the spinal cord that is comparable to the nearby subarachnoid space. Syrinx formation followed by accumulation of CSF in the spinal cord is widened .