Syringomyelia - Revision history

Rossdonaldson1: /* See Also */

2020-10-24T11:32:47Z

Rossdonaldson1: /* Evaluation */

2020-10-24T11:31:43Z

Evaluation

← Older revision		Revision as of 11:31, 24 October 2020
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	==Evaluation==		==Evaluation==
			[[File:Syringomyelia (with arrow).png\|thumb\|An idiopathic syrinx on MRI.]]
	*Imaging		*Imaging
	**[[head CT\|CT]] to rule out [[intracranial mass\|mass]], [[ICH\|bleed]], and [[hydrocephalus]]		**[[head CT\|CT]] to rule out [[intracranial mass\|mass]], [[ICH\|bleed]], and [[hydrocephalus]]

Rossdonaldson1: /* Background */

2020-10-24T11:12:55Z

Background

← Older revision		Revision as of 11:12, 24 October 2020
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	==Background==		==Background==
			[[File:Dermatoms alt.png\|thumb\|Sensory dermatome by spinal level.]]
	*Fluid filled cyst (syrinx) within the spinal cord which can expand or elongate over time, destroying surrounding spinal cord tissue.		*Fluid filled cyst (syrinx) within the spinal cord which can expand or elongate over time, destroying surrounding spinal cord tissue.
	*Can be due to dilation of the neural tissue surrounding the central canal itself (which can lead to obstructive [[hydrocephalus]]), or it can arise from within the parenchyma of the spinal cord.		*Can be due to dilation of the neural tissue surrounding the central canal itself (which can lead to obstructive [[hydrocephalus]]), or it can arise from within the parenchyma of the spinal cord.

ClaireLewis: /* Evaluation */

2019-10-02T22:28:54Z

Evaluation

← Older revision		Revision as of 22:28, 2 October 2019
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	==Evaluation==		==Evaluation==
	*Imaging		*Imaging
	**CT to rule out mass, bleed, and hydrocephalus		**[[head CT\|CT]] to rule out [[intracranial mass\|mass]], [[ICH\|bleed]], and [[hydrocephalus]]
	**MRI brain and spine will make the diagnosis though this may not be indicated in the ED setting		**[[brain MRI\|MRI brain]] and spine will make the diagnosis though this may not be indicated in the ED setting

	==Management==		==Management==

ClaireLewis at 17:45, 24 September 2019

2019-09-24T17:45:26Z

← Older revision		Revision as of 17:45, 24 September 2019
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	*Insidious onset		*Insidious onset
	*"Cape-like" distribution of:		*"Cape-like" distribution of:
	**Paralysis		**[[Weakness\|Paralysis]]
	**[[Paresthesia]]		**[[Paresthesia]]
	**Pain		**Pain
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	*Acute myelopathy		*Acute myelopathy
	*Brain [[stroke]]		*Brain [[stroke]]
	*Spinal cord stroke		*Spinal cord [[stroke]]
	*[[Central pontine myelinolysis]]		*[[Central pontine myelinolysis]]
	*Pediatric ependymoma		*Pediatric ependymoma
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	==Management==		==Management==
	*Ensure no respiratory involvement and consider intubation if severe		*Ensure no respiratory involvement and consider intubation if severe
	*Analgesia		*[[Analgesia]]

	==Disposition==		==Disposition==
	*Assuming pain is controlled and no concern for respiratory compromise, discharge home.		*Assuming pain is controlled and no concern for respiratory compromise, discharge home.
	*Neurology ~~followup~~- to create and monitor pain management plan		*Neurology follow-up- to create and monitor pain management plan
	*Neurosurgery- for potential surgical resection		*Neurosurgery- for potential surgical resection

Mfeigley: /* Background */

2018-11-30T12:48:50Z

Background

← Older revision		Revision as of 12:48, 30 November 2018
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	==Background==		==Background==
	*Fluid filled cyst (syrinx) within the spinal cord which can expand or elongate over time, destroying surrounding spinal cord tissue.		*Fluid filled cyst (syrinx) within the spinal cord which can expand or elongate over time, destroying surrounding spinal cord tissue.
	*Can be due to dilation of the neural tissue surrounding the central ~~can~~ itself (which can lead to obstructive [[hydrocephalus]]), or it can arise from within the parenchyma of the spinal cord.		*Can be due to dilation of the neural tissue surrounding the central canal itself (which can lead to obstructive [[hydrocephalus]]), or it can arise from within the parenchyma of the spinal cord.
	*Typically occurs in the C2 and T9 distribution.		*Typically occurs in the C2 and T9 distribution.
	*Most commonly occurs in patients with a pre-existing Chiari malformation.		*Most commonly occurs in patients with a pre-existing Chiari malformation.

ClaireLewis: /* Differential Diagnosis */

2017-08-22T14:19:01Z

Differential Diagnosis

← Older revision		Revision as of 14:19, 22 August 2017
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	*Spinal cord stroke		*Spinal cord stroke
	*[[Central pontine myelinolysis]]		*[[Central pontine myelinolysis]]
	*[[Malingering]]
	*Pediatric ependymoma		*Pediatric ependymoma
	*[[Diabetic neuropathy]]		*[[Diabetic neuropathy]]

ClaireLewis at 14:17, 22 August 2017

2017-08-22T14:17:30Z

← Older revision		Revision as of 14:17, 22 August 2017
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	===Types===		===Types===
	*Congenital		*Congenital
	**Secondary to ~~arnold chiari~~ malformation		**Secondary to Arnold Chiari malformation
	**Associated with [[hydrocephalus]]		**Associated with [[hydrocephalus]]
	*Acquired		*Acquired
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	==Clinical Features==		==Clinical Features==
			*Insidious onset
	*"Cape-like" distribution of:		*"Cape-like" distribution of:
	**Paralysis		**Paralysis
	**~~Paresthesias~~		**[[Paresthesia]]
	**Pain		**Pain
	*~~stiffness~~ of the back, shoulders, and extremities		*Stiffness of the back, shoulders, and extremities
	*~~loss~~ of ability to sense extreme hot or cold in the hands		*Loss of ability to sense extreme hot or cold in the hands
	*~~insidious onset~~		*Proprioception and vibration- spared due to sparing of the dorsal column and medial lemniscus

	==Differential Diagnosis==		==Differential Diagnosis==
	*[[~~Glioma~~]]		*[[Brain tumor]]
	*[[~~guillain~~-~~barré syndrome~~]]		*[[Guillain-Barré Syndrome]]
	*Acute myelopathy		*Acute myelopathy
	*Brain [[stroke]]		*Brain [[stroke]]
	*~~spinal~~ cord stroke		*Spinal cord stroke
	*[[Central pontine myelinolysis]]		*[[Central pontine myelinolysis]]
	*[[Malingering]]		*[[Malingering]]
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	==Evaluation==		==Evaluation==
	*Thorough history is going to be very important
	*Neuro Exam
	**cranial nerves
	**sensation- including hot and cold
	**proprioception and vibration- spared in syringomyelia due to sparing of the dorsal column and medial lemniscus
	**strength, especially in distal muscle groups

	*Imaging		*Imaging
	**CT to rule out mass, bleed, and hydrocephalus		**CT to rule out mass, bleed, and hydrocephalus
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	==Management==		==Management==
	*Ensure no respiratory involvement and consider intubation if severe		*Ensure no respiratory involvement and consider intubation if severe
	*~~Neurology consult~~		*Analgesia
	*pain management including some combination of NSAIDs, narcotics, and nerve modulators such as Gabapentin/lyrica

	==Disposition==		==Disposition==

Rossdonaldson1: /* Evaluation */

2017-05-26T18:20:54Z

Evaluation

← Older revision		Revision as of 18:20, 26 May 2017
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	**proprioception and vibration- spared in syringomyelia due to sparing of the dorsal column and medial lemniscus		**proprioception and vibration- spared in syringomyelia due to sparing of the dorsal column and medial lemniscus
	**strength, especially in distal muscle groups		**strength, especially in distal muscle groups
	*Notable Labs
	**inflammatory markers
	**LP
	*Imaging		*Imaging
	**CT to rule out mass, bleed, and hydrocephalus		**CT to rule out mass, bleed, and hydrocephalus

Rossdonaldson1: /* Differential Diagnosis */

2017-05-26T18:18:52Z

Differential Diagnosis

← Older revision		Revision as of 18:18, 26 May 2017
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	*Brain [[stroke]]		*Brain [[stroke]]
	*spinal cord stroke		*spinal cord stroke
	*[[Central pontine ~~myolinolysis~~]]		*[[Central pontine myelinolysis]]
	*[[~~malingering~~]]		*[[Malingering]]
	*Pediatric ependymoma		*Pediatric ependymoma
	*[[Diabetic neuropathy]]		*[[Diabetic neuropathy]]

← Older revision		Revision as of 11:32, 24 October 2020
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	==See Also==		==See Also==
			*[[Epidural compression syndromes]]

	==External Links==		==External Links==