Syringomyelia is a neurological disorder in which a fluid-filled cyst (syrinx) forms within the spinal cord. Cystic enlargement of spinal cord It starts medially and expands out Damages spinothalamic tract The syrinx can get big enough to damage the spinal cord and compress and injure the nerve fibers that carry information to and from the brain to the body.

1. SYRINGOMYELIA
Dr.Dhwani kawedia

2. SYRINGOMYELIA
syrinx
Cyst Cavity Spinal cord
Cystic enlargement of spinal cord
It starts medially and expands out
Damages spinothalamic tract

3. CAUSES
•Birth defects i.e. chiari malformation
•Hemorrage(bleeding)
•Inflammation of spinal cord i.e. meningitis
•Spinal cord injury (trauma)
•Spinal cord tumor

4. causes

5. Types
Syringomyelia
with foramen
magnum
obstruction and
central canal
dilatation
syringomyelia
and foramen
magnum
obstruction
syringomyelia
with other
diseases of
spinal cord
pure
hydromelia

6. CSF flows in
subarachnoid space
Obstruction of CSF pulsation
in subarachnoid space
result in syrinx
formation
Destroys structure
in the neighborhood
exerting
pressure
destruction of spinothalamic & later
AHC & degeneration of these axons
Compression of long ascending & descending
tracts leads to secondary degeneration
pathogenesis

7. Symptoms (sensory )
1
•Dissociated sensory loss
2
•Dysesthetic pain (neck & shoulder but may
follow in arm and trunk).
3
•When cavity enlarges to posterior columns,
position and vibration senses in feet are lost.

8. Symptoms (motor )
1
• LMN weakness in small muscles of the hand (bilateral or unilateral)
2
• BL spastic paralysis of both LL
3
• Exaggerated DTR.
4
• Positive barbinski’s
3
• Nystagmus

10. Investigation
MRI
Images of brain & spinal cord
EMG measures muscle weakness
CSF pressure levels fluid examination by performing a lumbar puncture
CT scans of brain may reveal the presence of tumours

11. PT assessment
• History – past history should include any sort of injury to spine as in accident.
Observation – mode of respiration, trophic changes, deformities
• Assessment of communication skills
• Cranial nerve assessment-
Corneal reflex
Jaw jerk
Function of muscle of mastication
Sensation of face & scalp
• Sensory evaluation – dissociate sensory loss
• Flexibility
• Tone asssessment
Flaccidity in the UL & spastic in the LL
• Muscle strength – weakness

12. • Muscle girth assessment – wasting in small muscles of the hand which may
progress proximally
• Postural evaluation & gait analysis
• Hand function assessment
Power grip
Precision
Prehension
• Functional independence assessment
• Investigations

13. PT management
• Improve relaxation
relaxed positioning
Yoga therapy & meditation
Massage
Jacobson’ s relaxation exercise
• Prevent chest complications –
PD, Chest expansion ex
Chest mobility & trunk mobility exercise
Correction of posture
• Sensory care & care of the skin
Colour coding of hot & cold
Use of cotton gloves
Proper footwear

14. Avoid pressure areas if bed ridden
Skin should be kept dry & clean
• Normalize tone in LL
Iceing, stretching, PNF, relaxation tech
Proper positionig, PNF exercise
• Management of paraparesis
Training of transfer
Stretching & Strengthening
Gait training
• Maintain flexibility & ROM
Stretching & strengthening
Bed mobility & mat activities
PNF- hold relax & contract relax

15. Reaching activities targeting at the end range
• Improve hand function
Fine motor & grip strengthening exercise
Use of adapted spoon & utensils in limited hand function
Use of protective gloves in loss of sensation
• Improve functional independence
Development of problem solving skills
Training in functional activities
ADL training like transfer, use of wheelchair
Environmental modification & architectural changes
Orthotic advise if necessary