SYRINGOMYELIA

OLEH:
ANDI PUTRI SUCI RAMADHANI
C 111 11 812

SUPERVISOR
DR. JAINAL ARIFIN, M.KES, SP.OT(K)SPINE
 DEFINITION

Syringomyelia is defined as cystic dilation of the

central canal of the spinal cord. There is cavitation
within the substance of the spinal cord.

The dilation of the cord leads to abnormalities in the

neurologic pathways that transmit pain and
temperature.
ANATOMY

Spinal cord is located

inside the vertebral canal.

End of the spinal cord are

between L1 and L2

Termination of spinal cord

called conus medullaris
CROSS SECTION OF SPINAL CORD

• Ascending tracts : Sensoric

• Desendens Tracts : Motoric
 ETIOLOGY

Types of Syringomyelia

 Communicating  Noncommunicating
Chiari I malformation Occult spinal dysraphism
Chiari II malformation Spinal cord trauma
Basilar arachnoiditis Spinal cord tumor
Spinal arachnoiditis
 PATHOPHYSIOLOGY

 The pathophysiology of syringomyelia following SCI

is not completely understood.

 Schlesinger’s 1895 monograph stated that there was

an associated congenital abnormality in one third of
the cases of syringomyelia that he had reviewed
 PATHOPHYSIOLOGY

 Theory of the pathogenesis of Syringomyelia

 W.J. Gardner – Hydrodynamic Theory “Water Hammer”

 B. Williams – Craniospinal Pressure Dissociation Theory
 E. Oldfield – Abnormal Pulse Wave Theory
 Cerebrospinal Fluid Flow

when the systolic CSF flow through the foramen magnum and the outflow from the 4th ventricle were
obstructed, ventricular CSF was forced into the central canal with each arterial pulse. This dilated the
central canal and eventually resulted in syringomyelia.
 CLASSIFICATION OF SYRINGOMYELIA

 Type I Syringomyelia with obstruction of the foramen

magnum and dilation of the central canal (developmental
type)
A. With type I Chiari malformation
B. With other obstructive lesions of the foramen
magnum

 Type II Syringomyelia without obstruction of the foramen

magnum (idiopathic developmental type)
 Type III Syringomyelia with other diseases of the spinal
cord (acquired types)
A. Spinal cord tumors (usually intramedullary,
especially hemangioblastoma)
B. Traumatic myelopathy
C. Spinal arachnoiditis and pachymeningitis
D. Secondary myelomalacia from cord compression
(tumor, spondylosis), infarction, hematomyelia

 Type IV Pure hydromyelia (developmental dilatation of

the central canal), with or without hydrocephalus
 CLINICAL MANIFESTATION

MOTOR SENSORY PAIN SPINCHTER AUTONOMIC

PROBLEM SYMPTOM
a. Muscle a. Decreased a. Midline pain a. Urinary a. Dysreflexia: wide
weakness and feeling in hands over the spine, incontinence, swings in blood
atrophy, and arms. particularly the sometimes with pressure, often
particularly in Depending on thoracic area spasticity of accompanied by
hands and arms extent and level of b. Burning pain in bladder profuse upper body
b. Increased syrinx cavity, legs arms, over trunk b. Fecal sweating
muscle tone may also be and rarely, legs incontinence b. Drooping of one
(stiffness or affected. Sensation c. Joint pain, c. Male impotence eyelid
spasticity) in arms involved may be particularly in c. Syncope (fainting
and/or legs pain perception, shoulders or near-fainting),
c. Abnormal temperature which is
curvature of the perception or relatively rare
spine (scoliosis) position sense.
b. Exaggerated
sensation
(hypersensitivity)
in limbs,
particularly arms
 DIAGNOSIS

 Diagnosis of syringomyelia are difficult to make

because the disorder had an insidious onset and a
variable clinical course.

 Currently, the diagnostic test of choice for

syringomyelia is the MRI.
A) Abnormal cerebral spinal fluid due to syringomyelia.
B) Normal cerebral spinal fluid flow post-surgery.
 TREATMENT

 Symptomatic Treatment
 Medications can be used to manage presenting symptoms but
they do not treat the syringomyelia it self.

 Surgical Treatment
 Shunting
 Shunting of the syrinx cavity can be performed using
syringoperitoneal, syringopleural, syringosubarachnoid, or
ventriculoperitoneal shunts.
THANK YOU