Diagnosis of Syringomyelia

       The diagnosis of syringomyelia based on a specific syndrome (clinical symptoms) and laboratory , and definitely diagnosis using MRI

1. Specific Syndrome
       Syringomyelia is a symptom complex of certain clinical signs due to the syrinx and gliosis in the spinal cord, the clinical diagnosis is based on: the location and size of the syrinx, the expansion of the syrinx, and the underlying cause, also a slowly progressive process that takes place .

2. Radiological

a. Myelography
Until recent years, Myelography still the standard procedure for making a diagnosis of syringomyelia. From the  spinal cord examination -shaped form, since the cessation of contrast fluid.

b. Computerized Tomography
CT scans can show the flow of CSF in the subarachnoid space or spinal cord cavitation. Overall these investigations are important in establishing the diagnosis. In spinal cord tumors showed a mass of tumor tissue and if there is a fluid-filled sac tumor as well, meaning that there is a closed syringomyelia cysts or even tumors both, spinal cord tumors and syringomyelia. This can be demonstrated by the occurrence of hemorrhage, ischemic, traumatic and other consequences. For syringohydromyelia cases, a CT scan is very useful because it looks abnormal presence of a syrinx in the spinal cord

c. Magnetic resonance imaging ( MRI )
These investigations indicate the presence of a cyst sac on the edge of the spinal cord and can be expanded . Therefore, the fluid-filled cyst will provide picture hypointensity on T1 and hyperintensity on T2 .
Some of these cysts associated with spinal cord tumors containing high liquid protein that picture looks less hiypointensity MRI, compared with CSF on T1. MRI longitudinal section, of syringomyelia, showed the presence of a thin transverse section but usually amounts to one bag syringomyelia.
Radiological evaluation is also very good with using MRI.
d. Laboratory
On examination cerebrospinal fluid generally normal, but in some cases obtained increased pressure and increased levels of the protein. Analysis of Cerebral Spinal Fluid: cell count of more than 10/mm3, the protein will be increased, in the case of subarachnoid blockage will increase to 100mg/dl. But usually not performed because of the risk of herniation and the possibility of subarachnoid blockage can occur.


Some of the following diseases should be considered in the diagnosis of syringomyelia

1. ALS (Amytropic Lateral Sclerosis)
The clinical manifestations of ALS may resemble syringomyelia, such as weakness or atrophy and loss of reflexes physiological decline that is usually unilateral, accompanied by increased reflexes physiology of the lower limbs. But in ALS is not accompanied by sensory disturbances. In addition to ALS fasciculations almost always there , being on syringomyelia is not always there.

2. Multiple Sclerosis
The disease is distinguished from syringomyelia of the intermittent course of the disease, the absence of a dissociative anesthetic, sclerosis or tropical disturbance. Multiple sclerosis can manifest as peripheral neuropathy, muscle atrophy, loss of reflexes and the onset of fasciculations and sensory disturbances.

3. Spinal arachnoiditis
Clinical symptoms of spinal arachnoiditis due to any cause, usually includes sensory radicular multilevel system disorders, amyotrophy and autonomic disturbances. Course of the disease is typically slowly progressive, although it can also be barlangsung relatively quickly. On examination of the lumbar puncture was obtained pleisitosis (10-50 cells/mm3) and the increase in the amount of protein (100-1000 mg %)

4 . Tumor Intramedulare
Nearly 60 % of tumors have a relationship with syringomyelia is intramedular, therefore clinically indistinguishable , but the MRI examination would be helpful to diagnose.

5 . Scalenus Anticus Syndrome
Scalenus anticus syndrome = thoracic outlet syndrome = cervical rib. The clinical manifestations of this disease in the form of discomfort along the medial side of the arm, paraesthesia in fingers IV and V, it is rare to syringomyelia . In advanced cases, obtained weakness, muscle atrophy and fibrillation are innervated by nerves C8 and Th1, sensory loss in one or both extremities are sometimes dissociative.

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