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Query: UMLS:C0026838 (spasticity)
 6,471 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The orthopaedic surgeon is often the first consultant to whom a patient with syringomyelia is referred. The disease is not as rare as he may suppose, but its early presenting features are very variable; if he relies solely on such familiar features as pes cavus and scoliosis, he may well miss the diagnosis. The commonest presenting symptom is pain in the head, neck, trunk or limbs; headache or neckache made worse by straining is particularly significant. A history of birth injury also may suggest the possibility of syringomyelia, especially if any spasticity subsequently worsens. Neurological features which may be diagnostic include nystagmus, dissociated sensory loss, muscle wasting, spasticity of the lower limbs or Charcot's joints. Radiographic features include erosion of the bodies of cervical vertebrae and widening of the spinal canal; if, at C5, the size of the canal exceeds that of the body by 6 millimetres in the adult, pathological dilatation is present. The presence of basilar invagination or other abnormalities of the foramen magnum, of spina bifida occulta and of scoliosis are further pointers. Thermography is a useful way of showing asymmetrical sympathetic involvement in early cases. A greater awareness of the prevalence of syringomyelia may lead to earlier diagnosis and to early operation, which appears to hold out the best hope of arresting what is all too commonly a severely disabling and progressive condition.
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PMID:Orthopaedic features in the presentation of syringomyelia. 15 24

In recent years, new neuroimaging techniques have revived interest in syringomyelia with respect to indications and results of surgery. Fifty patients, 36 of whom underwent surgery, have been reviewed. All patients but 3 underwent a new clinical assessment and 33 of them were also neurophysiologically investigated. In approximately one-third of the non-surgically treated patients the clinical course was benign. In 26 of the surgically treated patients an improvement was noted at the short-term assessment both for spasticity and pain, but in most of them it was not maintained in the medium term. Therefore, an accurate selection of the patients to be treated surgically is strongly recommended, particularly when the natural history of the disease is considered. Decompression of the posterior fossa seems to give the best results, yet no curative surgical treatment has been devised to date.
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PMID:The natural history and results of surgery in 50 cases of syringomyelia. 177 49

Between 1980 and 1990, 37 patients with cervical spondylotic myelopathy and syringomyelia underwent posterior decompression by laminectomy and dentatotomy. The preoperative symptoms are compared with the postoperative status. Spasticity and pyramidal signs were reduced. In our opinion, Kahn's indication for dentatotomy as described in 1946 is obsolete today. However, we believe that after extensive decompressive laminectomy an additional mobilising effect is recommendable, so that Kahn's operation is still of relevance as an additional procedure in the treatment of this condition.
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PMID:[Experiences with Kahn's method of dentatotomy]. 185 75

Motor and sensory nerve conduction and various F-response parameters have been examined in the median and ulnar nerves bilaterally in 22 patients with syringomyelia. Excluding those nerves with isolated peripheral lesions, motor and sensory conduction was normal in the distal nerve segments, except for one subject in whom severe wasting of the muscles was associated with slowed motor velocities. Minimum and/or maximum F-response latencies were increased in one or more nerves in 16 of the 22 cases, which was attributed to disturbed function of anterior horn cells and the intraspinal segment of the motor fibres, or mild subclinical nerve trauma. There was a tendency for F-response amplitude and duration to be increased, probably reflecting the combined effects of spasticity and enlargement of motor units due to reinnervation.
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PMID:F-responses in syringomyelia. 377 92

The authors reviewed the clinical findings, radiological evaluation, and operative therapy of 39 patients with syringomyelia. Syringoperitoneal (SP) shunting was used in 15 patients and other procedures were used in 24 patients. Follow-up periods ranged from 1 1/2 to 12 years. During the period of this study, metrizamide myelography in conjunction with early and delayed computerized tomography scanning replaced all other diagnostic procedures in patients with syringomyelia. Preoperative accuracy for the two procedures was 87%. The most common symptoms were weakness (79%), sensory loss (67%), pain (38%), and leg stiffness (28%). Surgery was most effective in stabilizing or alleviating pain (100%), sensory loss (81%), and weakness (74%); spasticity, headache, and bowel or bladder dysfunction were less likely to be reversed. Approximately 80% of patients with idiopathic and posttraumatic syringomyelia and 70% of those with arachnoiditis improved or stabilized. Better results were obtained in patients with less severe neurological deficits, suggesting the need for early operative intervention. A higher percentage of patients had neurological improvement with SP shunting than with any other procedure, especially when SP shunting was the first operation performed. Patients treated with SP shunts also had the highest complication rate, most often shunt malfunction. These results indicate that SP shunting is effective in reversing or arresting neurological deterioration in patients with syringomyelia.
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PMID:Surgical treatment of syringomyelia. Favorable results with syringoperitoneal shunting. 674 90

The operation of selective spinal cordectomy is rarely performed. The cases of 10 paraplegic patients who underwent this procedure are presented. Their clinical indications were varied, including posttraumatic syringomyelia, uncontrollable leg spasticity, posttraumatic spontaneous neurogenic leg pain, and repair of a myelomeningocele gibbus. The cordectomy specimen was available for pathological examination in nine cases. Specimens removed from or near the site of spinal cord trauma showed extensive gliosis, leptomeningeal fibrosis, and schwannosis. This latter feature possibly represents an attempt at spinal cord repair by the dorsal root ganglion cells. Four specimens contained a syrinx with features including a thick gliotic wall and enlarged Virchow-Robin spaces, features that have been implicated in the pathogenesis of posttraumatic syringomyelia. Clinical results in the patients with syringomyelia and uncontrollable leg spasticity have been excellent. Cordectomy did not provide permanent relief in the patients with neurogenic leg pain. The authors conclude that selective spinal cordectomy is a valuable procedure for specific indications.
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PMID:Selective spinal cordectomy: clinicopathological correlation. 694 22

Post-traumatic syringomyelia is now a well known entity and occurs months or years after a spinal cord injury. The presenting symptoms are usually pain, progressive motor weakness, sensory changes, and increased spasticity. Profuse sweating or hyperhidrosis can be a symptom of the post-traumatic syrinx or can occur in autonomic dysreflexia provoked by peripheral stimuli. We present two patients with cervical spine fractures whose presenting symptom of post-traumatic syringomyelia was hyperhidrosis affected by posture. The pathophysiology involved and the management of these patients is discussed.
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PMID:Hyperhidrosis as the presenting symptom in post-traumatic syringomyelia. 809 May 51

A 32-year-old woman experienced subacute onset of weakness in her left leg, urinary retention and difficulty in extending her right middle and third finger. She subsequently suffered episodes of myelopathy, optic neuritis and cerebellar ataxia over a period of several years. Brain MRI showed multiple areas of high signal intensity on T2-weighted images, consistent with multiple sclerosis (MS). However spinal MRI revealed no abnormal findings. In her most recent episode, at age 40 she developed paraparesis. Neurologic examination revealed down beat nystagmus on gazing to the right, horizontal jerk nystagmus gazing to the left, weakness of the right middle and third fingers and paraparesis associated with spasticity of the right leg. Sensory disturbance below C3 and diminished vibration and position sense in both legs were also observed. The patient could not stand or walk, and urinary disturbance was present. Spinal MRI revealed syrinx formation at the level of vertebral bodies C2 to C6. The syrinx within the cervical cord diminished in size after four months, but the patient was unable to walk unaided and had moderate sensory disturbance as before. This finding suggests that the prognosis of MS with syrinx formation following repeated episodes of myelopathy is not always favorable. We believe that functional recovery in MS with syringomyelia is affected by the severity of the demyelination and/or gliosis caused by MS rather than by the presence of the syrinx.
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PMID:[Multiple sclerosis with syringomyelia--case report]. 813 3

A 17-year-old boy presented with a 1-year history of progressive gait difficulties and slowing of fine hand movements. On neurological examination there was tetraspasticity, bilateral pes equinovarus and a decreased position sense in the feet. CT and MRI scan of the cervical spine demonstrated a spina bifida occulta of C1, an extensive intradural lipoma from the foramen magnum to C4 with a small intramedullary portion at C3, and a distal syringomyelia reaching down to D12. After excision of the extramedullary portion of the lipoma, there was a marked improvement of the gait and a reduction of the spasticity.
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PMID:Extensive cervical intradural and intramedullary lipoma and spina bifida occulta of C1: a case report. 845 14

A retrospective study was conducted on 21 consecutive patients with combined clinical and radiologic evidence of posttraumatic syringomyelia. Medical records and radiologic studies were reviewed to determine the following: age at injury, mechanism of trauma, spinal column injury and resultant neurologic deficit, latency period between injury and clinical manifestations of posttraumatic syringomyelia, clinicoradiologic findings of posttraumatic syringomyelia, and results of treatment. The patients were found uniformly to have sustained significant trauma (gunshot wounds, falls, or vehicular accidents) with marked neurologic dysfunction at the time of injury. Latent periods ranged from 1 month to 23 years. The most commonly presenting symptoms were radicular pain, spasticity, sensory loss, hyperhidrosis, and weakness. The most common physical findings were spasticity, hypesthesia, and weakness. Long term followup was obtained in 17 (81%) of the cases and suggested a higher rate of satisfaction among patients treated with surgical decompression of the syrinx. Radicular pain and sensory disturbance responded most predictably to surgical intervention, whereas spasticity responded least favorably. It is concluded that posttraumatic syringomyelia is a potentially disabling but treatable late complication of spinal injury, warranting a high index of suspicion among physicians who observe patients with such trauma.
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PMID:Posttraumatic syringomyelia: a review of 21 cases. 900 13


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