Pathophysiology
1) focal area of cystic, spongiform expansion of spinal cord (syrinx) 2) often produces a progressive myelopathy 3) most typical in high cervical and cervical/thoracic cord areas (although can occur anywhere in cord and also in medulla and pons) 4) syrinx is usually filled with collection of CSF 5) some cases result from blocked outflow of CSF from fourth ventricle through foramina of Luschka and Magendie to subarachnoid space (also occurs in absence of obstruction)
Signs and Symptoms
Typical – 1) “central cord syndrome” with pain and sensory loss in upper extremities 2) sensory loss to patient feels like a cape has been placed on back of neck, shoulders, and arms 3) arreflexia in upper extremities 4) weakness in upper extremities 5) muscle loss in same distribution as sensory loss 6) bladder/bowel dysfunction 7) spasticity and weakness in legs 8) Horner’s syndrome If associated with Arnold-Chiari malformation 9) cough 10) headache If affects medulla and pons – 11) vocal cord paralysis 12) dysarthria 13) nystagmus 14) recurrent dizziness 15) tongue weakness If affects descending tract of trigeminal nerve – 16) facial numbness and sensory loss
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