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Cervical vertebrae measurements in syringomyelia.

Lateral X-rays of the cervical spine taken under standard conditions in 69 cases of syringomyelia have been measured to assess the relative sizes of the canals and bodies. One hundred and five cases without cervical spine abnormality provided controls. The expected expansion has been observed in males from C5 to C7 and in females from C3 to C7. The oddity that the expansive process seemed to come higher in females than in males has been noted by other workers. In both sexes it has been found that diminution of vertebral body size is a more consistent finding than enlargement of the canals and correlation coefficients have confirmed that enlargement of the canal appears to take place at least in part at the expense of the body. Possible factors in the enlargement are discussed. Oblique measurements taken in 57 syrinx cases and 89 controls showed the expected change caused by the view of the lower cervical vertebrae being closer to AP and pictures of the upper vertebrae being progressively closer to lateral views. There was a tendency for the bigger oblique diameters to occur in these cases with the biggest sagittal diameters and an insignificant tendency for the biggest canals to have a diminished difference between the two oblique measurements. There was no evidence that oblique measurements could be used to detect slight degrees of enlargement in cases of syringomyelia.

Adult

Computerized axial tomography in syringomyelia.

The ACTA-scanner, a device for computerized axial tomography, permits cross-sectional radiographic study of the entire human body, including the spine. In the ACTA-scan, the spinal cord appears as a roundish formation surrounded by the less dense subarachnoidal cerebrospinal fluid. The spines of 18 patients with verified (nine cases) or suspected (nine cases) syringomyelia were studied by ACTA-scanning. In seven of the verified and in four of the nonverified cases, some evidence of cord cavitation was shown. The cystic part of a cervical-cord ependymoma was also demonstrated. ACTA-scanning is an easily performed, noninvasive, innocuous procedure. This technic, which complements other radiographic methods of evaluating the spinal cord, is particularly suitable for screening and follow-up study of patients with syringomyelia. The easily accomplished recognition of a possible associated hydrocephalus is an added advantage of ACTA-scanning.

Brain Diseases

Myotonic dystrophy, syringomyelia, and 2/13 translocation in the same family.

The present report describes a sibship with 2 individuals affected by myotonic dystrophy and a third with syringomyelia. The mother was affected by myotonic dystrophy. A balanced 2/13 translocation was detected in the individual with syringomyelia, in one affected by myotonic dystrophy and in their clinically normal father. The association between the phenotypic anomalies and the chromosome alteration is coincidental.

Chromosome Aberrations

A late neurologic complication of scoliosis surgery in connection with syringomyelia.

A case of scoliosis in connection with syringomyelia is described. Theories are proposed to explain the progression of the neurological symptoms after surgical correction and fusion of the deformity. Special points are emphasized that will aid in the recognition of syringomyelia in scoliosis patients. i) Abnormal neurology, in particular a dissociated disturbance of pain and temperature in the upper extremity. ii) Abnormal localization of a scoliosis curve. iii) Rapid progression of the scoliosis. iv) Bony anomalies of the upper cervical spine. v) Increased diameter of the cervical spinal canal.

Adolescent

Combined isotope ventriculography and lumbar myelocisternography in the diagnosis of communicating syringomyelia. Case report.

Several investigative procedures are currently used to diagnose communicating syringomyelia. The combination of isotope ventriculography and lumbar myelocisternography has never proposed nor carried out to verify this condition. We feel that this is a safe and valuable procedure to identify a patent central canal communicating with the fourth ventricle and is worth considering when diagnosing communicating syringomyelia.

Adult

Syringomyelia following lumboureteral shunting for communicating hydrocephalus. Report of three cases.

Three patients are described in whom syringomyelia was identified long after the treatment of communicating hydrocephalus by a lumboureteral shunt. The reason for syrinx formation in these cases could not be determined. In two there was either autopsy-proven or presumed evidence for arachnoiditis, and in the third patient the symptoms of syringomyelia were acutely aggravated by temporary obstruction of shunt. The development of a pressure drop from the intracranial compartment to the spinal compartment with crowding at the foramen magnum is also a suggested mechanism.

Adolescent

[Neuroradiological studies in syringomyelia].

In the years 1973--1975 20 patients with syringomyelia were treated surgically. The surgical interventions were preceded by careful radiological examinations which was often indispensable for confirmation of diagnosis, establishing of indications to operation and choice of surgical method. On plain radiograms in 16 cases cervicothoracic scoliosis was found, in 11 cases the vertebral canal was dilated in its cervical part, in 6 cases atlanto-occipital malformations were disclosed. The basic diagnostic examination was ascending myelography which was performed in 17 cases. In 3 cases the contrast medium failed to pass to the atlanto-occipital junction because of marked dilatation of the spinal cord in the cervical part. In 9 out of the remaining 14 cases radiological findings were compatible with the diagnosis of Arnold-Chiari syndrome which was confirmed during the operation. In 1 case positive contrast central pneumoencephalography was performed demonstrating a communication between the 4 th ventricle and the cavity in the spinal cord. Early detailed neuroradiological diagnosis is indispensable in syringomyelia for early surgical treatment.

Adolescent

[Dynamics of changes in vibration sensitivity in syringomyelia].

The state of vibrational sensibility was studied in 35 patients with syringomyelia, with the aid of a special device, which evoked in the tuning fork a vibration of the same amplitude (128) in repeated studies. The indices of vibrational sensibility in patients with syringomyelia were compared to normal figures. As a norm the author employed the medium indices of vibrational sensibility in seconds in 50 normals. According to the vibrational sensibility all the patients were divided into 4 groups. The absence of vibrational perception, its drop below the norm and appearance of hyperpallesthesia corresponded to the most severe forms of the disease. In a drop of temporal indices, but not lower than the norm, the side, where the pathological process was more marked under the treatment influence, showed a restituted vibrational feeling. Disordered vibrational sensibility was found not only to the level of affected segments, but beyond them, which supports the conductive character of these disturbances.

Adult

[Terminal ventriculostomy in the treatment of syringomyelia].

Terminal ventriculostomy is one of the methods used in surgical treatment of syringomyelia. The procedure is well tolerated and may be used in cases in which atlanto-occipital decompression is too serious an operation. The author used the method in treatment of 10 patients with different stages of syringomyelia. In 5 cases the time of follow-up was 12--20 months, in 2 of them the result was very good with very great improvement, in 3 improvement was slight but the progression of the disease was halted. In 5 cases with shorter follow-up improvement was observed in 3 and no improvement immediately after the operation in 2 cases. Further follow-up of these patients will show whether the results of the operation will be permanent.

Adult

[Pathogenesis of syringomyelia].

The absence of an ependimic layer in cases of syringomyelia described in literature and in the author's own studies, the dislocation of cavities on the background of formted gray matter, the structure of the edge of the cavity, as well as sclerosis, a gyalinosis of vessels and fibrosis of the meninx--all these phenomena confirm the opinion of syringomyelitic cavities as an acquired defect and not dysraphia. A comparative study of the morphogenesis of medullar cavities in inflammatory, vascular, traumatical processes and in syringomyelia permits to mark their histological similarity and postnecrotic genesis. The glyosis in syringomyelitic cavities has a different character. The fibrillar glyosis along the edge of the cavities appears due to reparative changes and plays a delineating role. Irritative glyosis appears more frequently in angiomatosis, accompanied by chronic microhemorrhages. Expressed glyosis with a formation of cellular rosettes is to a certain extent a tumor (astrocytomaa, epeudimoma), while a syringomyelitic cavity--a histiolytic cyst of a tumor.

Adolescent

Post-traumatic syringomyelia. Review of the literature and two new autopsy cases.

Two cases of post-traumatic syringomyelia studied macro- and microscopically are reported and compared with three previous autopsy cases described in the literature reviewed. The histological findings suggest that the pathogenesis may be explained by a pressure gradient in a small primary cavity. Although syringomyelia is a rare complication of traumatic spinal cord lesions, it is important to draw attention to the condition because it may be improved by surgical intervention.

Adolescent

Subarachnoid pouches of the posterior fossa with syringomyelia.

Three men are presented, all of whom were born with difficulty and later developed severe syringomyelia with collapsing cords on air myelography. Each had hydrocephalus and a sizable subarachnoid pouch in the posterior fossa. The clinical features and investigations are presented with a discussion of the aetiology and possible mechanisms concerned in pathogenesis and treatment. All three men had posterior fossa exploration over fifty years after birth, and the first two were also treated by valved ventriculo-atrial shunts. Each patient has improved a little since operation, but no certainty that this was due to surgery has been proved in any case; none has progressed since the last operation.

Cerebrospinal Fluid Shunts

Electrodiagnosis in post-traumatic syringomyelia.

Development of a syrinx several years post spinal cord trauma is a well-known entity and described in a number of scientific communications. Each one describes the few cases encountered with the clinical presentations; many report results of myelography with positive or negative contrast media, operative procedures, and eventual outcome as well as discussions of autopsy material. It is believed by many investigators and clinicians that surgical intervention frequently stops the progression of the syrinx and sometimes even reverses the symptomatology. Early exact diagnosis is thus paramount. Electromyography if used judiciously, may be an important adjunct to proper diagnosis and prognosis. In a patient with previous spinal cord trauma, frequently even post-surgical procedures, the interpretation is often difficult. This paper discusses the electrodiagnostic findings in three patients with post-traumatic syrinx and compares them with electrodiagnostic changes observed in a spinal cord injury patient with increased symptomatology due to other causes and two patients with non-traumatic cervical syringomyelia.

Adult

[Osteoarthrosis due to syringomyelia and its misinterpretation (author's transl)].

The development of severe deforming osteoarthrosis due to syringomyelia was observed over a period of 25 years; the changes are illustrated by a series of radiographs. A striking feature of this case, as in others, was the relative lack of symptoms complained of by the patient, when compared with the extensive joint destruction. It is necessary, if there is destruction of the shoulder, elbow or carpal joints, to consider a neuropathic cause and to take a very careful history, which unfortunately was not always done in our patients. Comparative radiographs of the opposite side should always be obtained.

Aged

Three cases of communication syringomyelia secondary to midbrain gliomas.

Three cases of midbrain gliomas are descrbied clinically and pathologically. In each case high pressure symptoms were followed by visual disturbance and the onset of syringomyelia symptoms before death. All the patients had hydrocephalus. In one case with concomitant syringobulbia, the syrinx appeared to due to CSF communicating with the cord cavity through the tissues of the brain stem. In the other cases the communication between the CSF pathways and the syrinx was at the usual site, through the central canal at the obex.

Adolescent