home Audience 1 What kind of nails are there in syringomyelia? Chronic disease syringomyelia: what it is and how to treat progressive pathology of the nervous system. Causes and types of disease

What kind of nails are there in syringomyelia? Chronic disease syringomyelia: what it is and how to treat progressive pathology of the nervous system. Causes and types of disease

Main symptoms:

Syringomyelia is a disease of the nervous system that develops as a result of disruption of the neural tube in the fetus (during its stay in the mother’s womb) or as a result of injuries and diseases affecting the spinal cord. If this pathological condition progresses in a person, then areas of proliferation of connective tissue, the so-called glia, form in the substance of the spinal cord. Over time, they disintegrate and cavities form, which are filled with cerebrospinal fluid. The danger also lies in the fact that they tend to grow rapidly.

As a result of the progression of syringomyelia, pathological voids with fluid are formed instead of healthy nervous tissue. As a result, those parts of the human spinal cord that “came under attack” and were compressed or pinched by cavities cease to function normally. For the most part, this is what causes the clinical signs of the disease.

Classification

Clinicians divide syringomyelic cysts into:

communicating. A cyst forms, connecting to the canal through which the spinal cord passes. In this case, they talk about a congenital anomaly of the central nervous system;
non-communicating. The syringomyelic cavity does not have a lumen associated with the pathways along which the cerebrospinal fluid moves. In this case, the cavity is a completely isolated space. Pathology develops as a result of past illnesses.

Pathological cavities form and grow along the anterior or posterior surface of the spinal cord. The diameter of the cavities is different. They can be completely invisible, or have a diameter of up to 2 cm.

Causes

There are many factors that could provoke the progression of syringomyelia. Depending on the reasons that caused the disease, clinicians divide syringomyelia into:

primary or true;
secondary.

True

This form develops as a result of disturbances that occurred during the intrauterine development of the fetus, at the stage of the formation of its central nervous system. In the first 3 months of fetal development, under the influence of synthetic medical drugs and other unfavorable factors, abnormal formation of the spinal cord occurs, which, in turn, leads to the formation of cavities and outgrowths.

Secondary

This disease develops in a normally formed and functional spinal cord after illness and injury. The main reasons for the progression of the disease:

tumors;
injuries;
previous neurological operations;
tuberculous or purulent lesion of the membranes of the brain.

Symptoms

Symptoms of the disease may not appear for a long time. A simple cough or sneezing can trigger the appearance of symptoms. The disease is characterized by the development of 3 groups of disorders:

vascular;
sensitive;
motor.

Sensory disorders

This type of disorder is characterized by the following symptoms:

a person does not feel pain in certain areas;
the patient ceases to feel temperature.

Vascular disorders

In this case, the symptoms are pronounced. At the beginning of the progression of the disease, increased sweating is observed in the upper part of the body, as well as on the face. As syringomyelia begins to develop, these symptoms are also accompanied by peeling skin and dryness. As a result, deep cracks and ulcers form, which heal very poorly. The nail plates weaken and begin to crumble and break.

In severe cases, the large joints of the limbs are affected - they are affected. Curvature of the spine can also often occur.

Movement violations

In this case, the main symptom is paresis in the muscles of the hands. The patient notes that it is difficult for him to button clothes, write, lift small objects, and even lace his shoes. The muscles of the hands gradually atrophy (shrink out). As a result, a “clawed hand” is formed - a characteristic symptom of the pathology. If a person is affected by syringomyelia, then the tendon reflexes gradually decrease, to the point that they disappear completely.

If syringomyelia also affects the lateral parts of the spinal cord, then the symptoms described above begin to manifest themselves on the legs. If syringomyelic cysts have formed in the medulla oblongata, then the nerve nuclei will gradually begin to destroy.

As a result, the following violations will occur:

decreased hearing function;
violation of the swallowing reflex;
speech disorder.

Diagnostics

If the above symptoms of syringomyelia appear, making an accurate diagnosis will not be difficult. Later, other instrumental diagnostic methods are prescribed to confirm it. MRI is the most effective for syringomyelia. In the resulting images, it is possible to see the presence of pathological cavities or an increase in the size of the spinal cord.

Additional diagnostic methods:

immunological research;
rheoencephalography.

Treatment

Treatment of this spinal cord disease is very complex and is carried out throughout the patient’s life. The treatment method is selected taking into account the severity and characteristics of the pathology and includes the following:

correct mode;
conservative treatment methods;
surgery.

Drug treatment includes the following:

amino acids;
vitamin complexes;
drugs that stimulate blood circulation in the vessels of the brain;
drugs that improve the conduction of nerve impulses.

Treatment with medications is carried out in courses - 2-3 times a year.

If syringomyelia occurs rapidly and the clinical symptoms are more than pronounced, then surgical treatment of the disease is indicated. Its essence lies in the fact that the surgeon installs a special device. shunts between the formed syringomyelic cavities. After this type of treatment, the patient will need to undergo a long course of rehabilitation.

Treatment of the disease is carried out only in hospital conditions and under the constant supervision of doctors. Only in this case will it be effective. Treatment at home with various folk remedies is unacceptable, as it can lead to the development of various complications.

Forecast

Syringomyelia is not fatal. Patients with this disease remain able to work for a long time. Often we encounter patients in whom periods of exacerbation are followed by periods of calm (25%). In 60% of patients, the disease progresses slowly, and in 15% it does not progress at all.

Is everything in the article correct from a medical point of view?

Answer only if you have proven medical knowledge

) is a chronic, slowly progressive disease of the nervous system, which is characterized by the formation of cavities in the spinal cord, and sometimes in the medulla oblongata, due to pathological expansion of the central canal filled with cerebrospinal fluid. The true form of syringomyelia is associated with congenital pathology of glial tissue; other cases (the majority) are the result of anomalies and diseases of the craniovertebral zone.

Causes

It is important to understand that syringomyelia is most often not a separate disease, but is considered a syndrome that is characteristic of pathological conditions accompanied by compression of the subarachnoid space at the level of the craniovertebral junction and the cervicothoracic spinal cord.

Depending on the etiology, the following types of syringomyelia are distinguished:

pathology due to the presence of structural anomalies and pathologies of the posterior cranial fossa (Arnold-Chiari malformation, basilar impression, arachnoid cysts, etc., tumors of the posterior cranial fossa);
post-traumatic form;
due to previous neurological infections (meningitis, arachnoiditis);
syringomyelia associated with spinal cord tumors;
pathology associated with non-tumor compression of spinal tissue (herniated intervertebral discs of the cervical and thoracic spine, large foci of demyelination of the spinal cord in the case of the development of multiple sclerosis);
idiopathic syringomyelia (in cases where the cause of the formation of syringomyelic cysts remains unknown).

The development of syringomyelia is based on the formation of cerebrospinal fluid cavities in the tissues of the spinal cord

Arnold-Chiari malformation and syringomyelia

In approximately 80% of cases, syringomyelia is combined with a congenital disorder of the vertebrobasilar junction, such as Arnold-Chiari anomaly (AAC). This is a congenital malformation of the rhomboid brain, which is characterized by a discrepancy between the size of the posterior cranial fossa and the anatomical structures of the nervous system that are located in it. This leads to the descent of the brain stem and cerebellar tonsils into the foramen magnum and pinching them at this level.

Under normal conditions of development of the posterior cranial fossa, the cerebellar tonsils are located above the foramen magnum, and in patients with AAC they sometimes descend to the level of the 1st or 2nd cervical vertebra, thus blocking the normal flow and circulation of cerebrospinal fluid, which becomes the direct cause of the formation of syringomyelia (damage to the spinal cord) and/or syringobulbia (formation of cerebrospinal fluid cavities in the tissues of the medulla oblongata).

Normal structure of the posterior cranial fossa

Arnold-Chiari malformation

It is important to know! Previously, it was believed that AAC is congenital, but now some researchers believe that the descent of the cerebellar tonsils into the foramen magnum occurs during rapid growth of the brain in conditions of a slow increase in the bone tissue of the skull (due to which, in fact, an anatomical discrepancy in size develops) .

Scheme of development of type 1 Arnold-Chiari malformation

As already mentioned, approximately 80% of cases of AAC are combined with the formation of syringomyelic cavities in the spinal cord. The average age of onset of the disease is 25-40 years. There are several types of AAC. Syringomyelia is usually combined with type 1 pathology.

Some patients with AAC do not develop syringomyelia throughout their lives. Until now, researchers cannot understand why these cavities form in some patients and not in others with the same disorder.

Pathogenesis of the disease

If we turn to modern views on the mechanism of development of syringomyelia, it is the result of abnormal circulation of cerebrospinal fluid (CSF) in the cerebrospinal fluid pathways of the central nervous system.

Normally, cerebrospinal fluid is produced in the choroid plexuses of the lateral ventricles of the brain and is absorbed into the blood by special structures of the arachnoid membrane of the brain and spinal cord. During the day, complete renewal of the CSF occurs approximately 4-5 times. If certain obstacles to normal circulation or absorption of cerebrospinal fluid arise in the subarachnoid space, then some pathologies develop, including syringomyelia.

Ventricles and cerebrospinal fluid tracts

There is no single generally accepted mechanism for the formation of syringomyelic cavities. Today there are several theories about the pathogenesis of this disease of the nervous system.

Diagram of normal circulation of cerebrospinal fluid

To understand in more detail how and why syringomyelia develops, it is also necessary to have an understanding of the central canal of the spinal cord. In the womb, a child goes through several stages of development in stages. The formation of the brain and spinal cord is a very complex process, and at one of its stages, the human embryo has a fissure (central canal) along the entire length of the spinal cord. Unfortunately, the exact function of this intermediate anatomical formation has not yet been established.

After the birth of a child, the central canal gradually fills up; the pace and completeness of filling the central canal can vary significantly from person to person. MRI may show remnants of the central canal in some adults, but most do not.

According to the most popular theory of the development of syringomyelia today (W.J. Gardner 1950), difficulty in the outflow of cerebrospinal fluid from the cistern magna into the subarachnoid space of the spinal cord is accompanied by strong hydrodynamic impacts of CSF from the 4th ventricle onto the walls of the central canal of the spinal cord (if a person has one) or to the area of its obliteration. The latter is associated with the expansion of the canal and/or the formation of syringomyelic cavities.

Scheme of the development of syringomyelia in Arnold-Chiari malformation

The development of syringomyelia due to injuries and tumors of the spinal cord, intervertebral hernias of the cervical spine proves that the cause of syringomyelia can be not only a violation of the patency of the subarachnoid space at the vertebrobranial level, but also in the region of the cervical and sometimes thoracic spinal column.

Classification

Pathology has an ICD-10 code (International Classification of Diseases, 10th revision) G 95.0. In addition to the described etiological classification, there are several more options. Depending on the location of the cavities along the length of the spinal cord, forms of syringomyelia are distinguished:

bulbar - liquor cysts are located in the tissue of the medulla oblongata (syringobulbia);
cervicothoracic – cavities are localized in the cervical and thoracic spinal cord;
lumbosacral – cysts are found in the lumbar and sacral regions;
mixed - cerebrospinal fluid cysts are localized in several parts of the spinal cord simultaneously.

Depending on the impaired functions of the spinal cord:

sensitive form;
motor;
trophic;
mixed.

Depending on the development mechanism:

communicating (when the syringomyelic cyst communicates with the central canal of the spinal cord);
non-communicating (when the cyst does not have an anatomical connection with the spinal cord fluid tracts, but exists separately from them).

What is the syringomyelic cavity?

Most often, such cavities are located in the cervical, cervicothoracic regions of the spinal cord, but they can spread higher - into the medulla oblongata (syringobulbia). They have an oblong shape, different lengths and widths in diameter. Inside the cavities there may be membranous septa that divide the cyst into many separate compartments. Inside the cysts there is cerebrospinal fluid, and there is also a proliferation of glial tissue, as a result of increased pressure of the CSF on the walls of the cerebrospinal fluid cavities.

Symptoms of syringomyelia depend entirely on the extent and location of the cerebrospinal fluid cavities in the spinal cord

Syringomyelia symptoms

The clinical picture of syringomyelia simultaneously combines several types of neurological disorders:

sensitive;
motor;
vegetative-trophic;
pain syndrome.

Pain syndrome

Pain is most often the first symptom of the disease, but due to its nonspecificity, it remains unrecognized for a long time. As a rule, the pain is unilaterally localized in the neck and shoulder, upper extremities, sometimes the back and legs hurt. The pain is of a pulling and aching nature. Pain is associated with damage to the posterior horns of the spinal cord, and asymmetry of pain is associated with uneven spread of the cyst to the right and left parts of the spinal cord.

Sensory disorders

Often patients complain of the development of paresthesia - a feeling of crawling, coldness or burning of the skin, tingling, numbness. Characteristically, there are areas of skin with impaired and preserved sensitivity (this depends on which segments of the spinal cord are affected, since the innervation is segmental in nature).

Scheme of segmental innervation of the spinal cord

As the disease progresses, pain and temperature sensitivity is gradually impaired (decreases and then disappears). This leads to frequent tissue injury, for example, painless burns. Deep types are sensitively disrupted only in very late stages of pathology.

Violations are sensitively of the nature of a “collar”, “jacket”, “half-jacket”. Often between zones with impaired sensitivity there are areas of the skin with normal sensory function, which is associated with the peculiarities of the segmental innervation of tissues and organs by the spinal cord.

Movement disorders

Impaired motor function of the spinal cord occurs in 60-85% of patients with syringomyelia. The earliest to appear is muscle atrophy (weight loss) due to damage to the anterior horns of the spinal cord and their motor neurons. Then muscle weakness and flaccid paralysis of damaged muscle groups develops. Initially, the process is one-sided, but later the muscles on the other side of the body can be affected.

Since the formation of syringomyelic cysts most often begins in the cervical and cervicothoracic spinal cord, the small muscle groups of the hands, muscles of the forearm, shoulder, shoulder girdle, and upper intercostal spaces are the first to suffer.

Motor disorders and the development of amyotrophies in syringomyelia become causes of disability in such patients

If the medulla oblongata is involved in the pathological process, bulbar symptoms develop - paralysis of the muscles of the soft palate, pharynx, vocal cords with impaired swallowing and voice. Other movement disorders may also occur (it all depends on which part of the medulla oblongata or spinal cord is affected by the syringomyelic cavities). The function of the pelvic organs is rarely impaired, since the lumbosacral spinal cord is not often affected.

Patients with syringomyelia have impaired pain and temperature sensitivity, which causes frequent injuries and burns

Vegetative-trophic symptoms

The pathology is very characterized by the development of trophic disorders. In 20% of patients, Charcot joints are diagnosed (enlargement of the joint, its deformation, impaired movement in the joint in the absence of pain).

The photo shows Charcot's joints

Frequent trophic disorders also include a bluish tint of the skin, increased keratinization of the skin, increased sweating, and thickening of subcutaneous fatty tissue in certain areas of the body, for example, on the fingers, which is why they take on the appearance of “banana bunches.”

Other signs

Very often, patients with syringomyelia experience a variety of combined anomalies:

deformations of the chest and spine, for example, kyphoscoliosis;
cervical ribs;
disproportionate size of the upper extremities (very long arms, which must be taken into account when making a differential diagnosis with Marfan syndrome);
hair growth disorder;
abnormalities in the structure of the ears;
hydrocephalus;
various craniovertebral anomalies.

Kyphoscoliosis is often observed in patients with syringomyelia

The course of the disease and the severity of its symptoms depend, first of all, on the cause. The most pronounced pathological symptoms are in cases where syringomyelia is caused by craniovertebral anomalies. In some cases, manifestations of pathology may be mild and disguised as the underlying disease, for example, intervertebral hernia of the cervical spine, spinal tumor, multiple sclerosis.

Diagnostics

The main method for diagnosing syringomyelia is magnetic resonance imaging (MRI), which allows not only to identify syringomyelic cavities, Arnold-Chiari malformation and other lesions that may be the direct cause of the disease (tumor, intervertebral hernia, etc.), but also to determine the size, localization of cysts, their extent in the spinal cord, internal structure.

Computed tomography in myelographic mode can also be used to diagnose the disease, but MRI in this case has more advantages and is better informative, therefore it is considered the “gold standard” for diagnosing syringomyelia.

Arrows indicate the presence of syringomyelic cavities in the spinal cord: A – on MRI, B – on CT

In the advanced stage of the disease, diagnosis does not present any difficulties, since the patient has a clear clinical picture of a segmental type of sensory disturbances, movement disorders, trophic changes and pain. It is much more difficult to suspect a disease at the very beginning of its development, when the described disorders have not yet manifested themselves, and only chronic low-intensity pain is present.

Treatment of syringomyelia

Therapeutic tactics completely depend on the cause of syringomyelia and the nature of the pathological process. There is no need to treat the disease if it does not progress against the background of idiopathic forms and craniovertebral anomalies. Such patients should be monitored over time by a neurologist.

If the pathology rapidly progresses, surgical treatment of syringomyelia is necessary. The type of surgery depends on the cause of the disease. In case of operability, the tumor and intervertebral hernia are removed. In case of AAC, craniovertebral decompression is performed to normalize the process of outflow of cerebrospinal fluid from the 4th ventricle of the brain into the subarachnoid space.

Scheme of surgical treatment of Arnold-Chiari malformation

If the disease has developed due to inflammatory changes in the central nervous system (arachnoiditis, meningitis) or is idiopathic but progressive in nature, syringal shunt surgery is used. Also, if necessary, medication and other conservative treatment of motor, trophic and sensory disorders are prescribed.

Forecast

60% of patients experience a chronic and slowly progressive course of syringomyelia; as a rule, they are diagnosed with an idiopathic form of the pathology. In approximately 25% of cases, stages of increasing clinical symptoms are replaced by long periods of the patient’s stationary condition. And only in 15% of people with syringomyelia the disease does not progress at all.

The prognosis is relatively favorable, since patients remain able to work for a long time, avoiding disability for many years. A severe course of the disease is observed with syringobulbia, since the involvement of the respiratory center and nuclei of the vagus nerve in the pathological process leads to a rapid fatal outcome.

In neurological practice, a disease such as syringomyelia of the cervical and thoracic spine occurs. Syringomyelia itself does not affect a person's life expectancy. Possible complications pose a danger: the development of sepsis, depression of the respiratory center, damage to the vagus nerve. What is the etiology, symptoms and treatment of this disease?

Syringomyelia is a chronic, slowly progressive disease of the central nervous system characterized by the formation of small cavities in the spinal cord. This disease is included in the list of diseases according to ICD-10, syringomyelia code G 95. Syringomyelia mainly affects the spinal cord. In some cases, damage to the medulla oblongata is possible. The spinal cord is located in the spinal canal. The most commonly diagnosed cases of syringomyelia are the cervical and thoracic spine. This pathology accounts for up to 7% of all cases of diseases of the nervous system.

There are congenital (true) and acquired forms of the disease. In the first case, the disease develops against the background of active proliferation of glial cells. The latter are auxiliary cells that perform a trophic function. They are not involved in the conduction of nerve impulses. Cavities in the gray matter of the spinal cord are formed during the massive death of glial cells. The cavities gradually increase in size. This can compress the nerve fibers. Both motor and sensory neurons are affected. Very often, congenital syringomyelia of the spinal cord is combined with damage to the spine.

The manifestation of the disease most often occurs between the ages of 25 and 40 years. Men suffer from this disease more often than women. More than half of patients develop secondary (acquired) syringomyelia. It is caused by damage to the area connecting the spine to the skull. Causes of secondary syringomyelia include: injuries to the spine and spinal cord, spinal cord infarction, hemorrhage, herniated discs of the cervical or thoracic vertebrae, inflammation of the arachnoid mater, multiple sclerosis, tumors of the thoracic or cervical spinal cord, tuberculosis.

Main clinical manifestations

ICD-10 identifies only types of syringomyelia; the symptoms are not indicated. The following signs of the disease are distinguished:

weight loss;
decreased tone of small muscles of the hands;
disturbance of sensitivity or its complete loss;
thermal injuries to the skin;
thickening of the skin;
change in skin color (cyanosis);
dull pain in the cervical or thoracic spine;
facial pain;
joint deformation;
frequent fractures;
thickening of the fingers.

Impaired temperature and pain sensitivity is a valuable diagnostic sign. Such people are unable to distinguish hot from cold, which ultimately leads to burns. When the spinal cord is damaged, pain sensitivity is also lost. At the same time, patients do not notice the injuries they receive, which can lead to negative consequences. All these symptoms are associated with damage to the posterior (sensitive) horns of the spinal cord in the thoracic and cervical region.

The anterior horns may also be involved in the process. There are motor neurons that are directly connected to the muscles. In this situation, patients may complain of decreased muscle strength, difficulty moving, and weakness. A specific symptom of cervical syringomyelia is Horner's syndrome. It is manifested by constriction of the pupil, drooping of the upper eyelid and enophthalmos (retraction of the eyeball back). Symptoms may include leg paresis and pelvic organ dysfunction. Additional symptoms of syringomyelia include excessive sweating.

9 factors of occurrence.

Treatment of patients is carried out only after a thorough neurological examination. Diagnostics includes taking an anamnesis, assessing pain and temperature sensitivity, external examination, determining reflexes, performing computed tomography or magnetic resonance imaging of the spine, myelography, general blood and urine tests. Collection of anamnesis of the disease and life history is of great importance. An experienced neurologist must know how to treat syringomyelia of the cervical and thoracic regions. Conservative treatment without surgery is possible in the early stages of the disease.

Conservative treatment involves the use of radioactive iodine or phosphorus, diuretics (Furosemide), neuroprotectors, vitamins, and myotropic antispasmodics (Dibazol).

Neuroprotectors are necessary to protect nerve cells. Of this group, Piracetam and Actovegin are most often used. To eliminate pain, analgesics (Analgin) and ganglion blockers are used. To calm patients down, antidepressants and antipsychotics are often prescribed. To improve the transmission of nerve impulses, it is advisable to prescribe Prozerin. Additionally, physical therapy may be performed. If there is paresis of the upper limbs and there is no effect of drug treatment, surgical intervention is performed.

During the operation, the cavities are drained, adhesions are removed, and the spinal cord is decompressed. The health prognosis is favorable in most cases. The most dangerous is damage to the respiratory center. Burns can cause infection, which if left untreated can cause sepsis. Thus, spinal syringomyelia is a rare neurological disease. The disease can be asymptomatic for a long time.

If sensitivity is impaired and causeless burns appear on the body, you should contact a neurologist and undergo an examination. Consultation with other specialists may be required.

Cervical syringomyelia most often occurs in people after 25-30 years of age. This disease appears unnoticed and cannot be completely cured.

It may go into remission, but the disease cannot be cured completely. The only way out will be timely treatment. It will ensure a fuller and longer life.

The process of occurrence of syringomyelia of the cervical and thoracic spine:

The spinal canal expands.
Liquid flows in this channel. She begins to avoid obstacles that appear in her path.
Cavities appear in the canal. They arise in places of detours.
Glial cells appear. Their formation is associated with the appearance of cavities.

Spinal diseases can rightfully be called the scourge of modern man. The appearance of some of them is caused by an incorrect lifestyle, while others arise after infection. The latter group also includes spinal tuberculosis, which is a dangerous and contagious disease.

As a result, the transmission of impulses from the brain to the organs is disrupted. Doctors have not yet figured out why such phenomena occur in the body. There are only theories to explain this disease.

Manifestations of the disease

Sudden weight loss indicates the first manifestations of syringomyelia. At the same time, the hands become noticeably weaker and sensitivity to pain and temperature decreases. Over time, it spreads to other areas of the body.

Important: At the initial stage, most patients often burn themselves or cut their skin due to decreased sensitivity. At this stage you need to be careful.

The next stage is characterized by the appearance of aching pain in the limbs. Neurological pain occurs in the facial area. After this, the patient develops paresis of the upper and lower extremities. Tendon reflexes disappear and it becomes difficult to move independently.

The patient may have no sweating at all. In some cases, on the contrary, increased sweating appears.

Diagnostics

At the first symptoms of syringomyelia, the patient needs a neurological examination. Diagnostics includes:

Inspection by external signs.
Sensitivity to pain and temperature is checked.
Anamnesis collection.
Definition of reflexes.
A tomography of the spine is performed.
Tests (blood and urine) are taken.

Based on the examination results, the doctor prescribes treatment.

Treatment and prevention

It is impossible to completely get rid of the disease. But proper treatment will stop the development of the pathology and alleviate the symptoms.

Important: To eliminate pain symptoms, the doctor prescribes x-ray therapy. With this therapy, a specific area of the body is irradiated. But this method is used in the early stages.

Proserine therapy is also used in the early stages. This method significantly normalizes the transmission of impulses, and the patient's condition improves. But this procedure does not affect the formation of cavities in the cervical and thoracic spine.

The use of radioactive iodine or phosphorus has a significant effect on the formation of cavities. These elements are capable of inhibiting the growth of glial cells.

In the later stages of the disease, surgical intervention is prescribed. Often prescribed to patients whose symptoms progress.

If the first symptoms of syringomyelia of the cervical and thoracic spine occur, you should immediately consult a doctor and undergo an examination.

Syringomyelia is characterized by the formation of cavities or cysts in the spinal cord. The disease can be caused by a number of pathologies of the spinal cord and central nervous system, as well as injuries.

Syringomyelia according to ICD-10 is assigned code G95.0. The exact causes of syringomyelia have not yet been reliably studied. Pathology can appear in a number of diseases, such as oncological diseases of the spinal cord or its injuries.

The pathology is characterized by the formation of cavities in the spinal cord. This occurs due to the rapid proliferation and further breakdown of glial tissue, as a result of which the dynamics of the cerebrospinal fluid is disrupted.

The disease can occur as a result of a congenital abnormality of the spinal cord and skeleton. Often the cause of the pathology is the improper development of the nervous system in the prenatal period. Syringomyelia can also be caused genetically. The disease is often diagnosed among the population of regions with low migration rates.

Another likely reason for the appearance of spinal cord irregularities is a lack of nutrients necessary for the formation of the nervous system during the prenatal period.

Due to the structure of the skeleton, syringomyelia of the neck or lumbar region is most common. This is due to the peculiarities of the dynamics of cerebrospinal fluid in these areas of the spine.

Syringomyelia is a chronic disease of the nervous system; it is not possible to cure the pathology. Prognosis, supportive therapy and symptoms depend on the form of the disease.

Syringobulbia is a similar disease that affects other parts of the spinal canal. Syringomyelia and syringobulbia are classified equally according to ICD 10.

How does syringomyelia develop?

A pathology caused by a congenital disorder of glial tissue is called true syringomyelia. In this case, there is a tendency to increased growth of cells in the glial tissue of the cerebrospinal fluid of the cervical and lumbar spine. In order for glial tissue to grow, it is necessary to be exposed to some provoking factor - this could be an infectious disease or injury to the spinal canal.

The rapid proliferation of cells leads to the fact that over time they die, forming cavities. Fluid accumulates in the cavities, which is why the disease is often called cystic formation of the spinal cord. Due to the accumulation of fluid, the cavity increases in size, which leads to irritation of adjacent nerve cells. As a result, nerve cells are compressed, degenerate and die.

The more the disease progresses, the more cavities are formed. As a result, the number of dying nerve cells increases.

True syringomyelia is accompanied by congenital anomalies of skeletal development. Patients often experience severe scoliosis, kyphosis, increased arm length, abnormal development of fingers (six-fingered), skull asymmetry, and bifurcation of the tongue. This form of the disease is familial in nature, that is, it is observed in several generations of the same family. Most often, true syringomyelia occurs in men aged 20-50 years.

True syringomyelia is a rare disease that occurs in no more than 30% of cases. The most common form of the disease is associated with an abnormal development of the craniovertebral junction - that is, the area where the spine connects to the skull. This is a congenital structural anomaly that provokes expansion of the spinal canal. Due to this expansion, the gray matter filling this area is gradually destroyed, causing the development of syringomyelia.

Symptoms of pathology

Syringomyelia disrupts the integrity of the spinal cord. This leads to the development of symptoms of nervous system dysfunction.

Syringomyelia symptoms are caused by the death of nerve cells due to an increase in the size of the spinal canal. The disease is characterized by the following symptoms:

The first symptom of the development of the disease is headache. Patients may also complain of pain in the hands and lower extremities. Due to damage to nerve cells, skin sensitivity is impaired. This usually affects the skin of the torso; the lower extremities are involved in sensory disturbances much less frequently. The abundance of injuries, minor household burns and cuts makes it possible to determine the manifestation of sensitivity disorders, since during traumatic exposure the patient does not feel pain and may not notice the damage for a long time.

Horner's syndrome is characterized by a triad of symptoms of a neurological disorder - weakening of the eyelid, enlarged pupils and sunken eyes. In this case, eye nystagmus may be observed - a violation of the movement of the eyeball. Horner's syndrome is usually observed with cervical syringomyelia.

Syringomyelia of the cervical and thoracic spine may be accompanied by trophic changes in the skin and joints. This is manifested by degenerative changes in the joint tissue, as well as the formation of growths and deformation of the joints. Typically the changes affect the shoulder and elbow joints.

Patients may experience gradual atrophy of the hands with corresponding impairment of reflexes. In this case, the nail is affected and the nail plate may peel off. The development of short-term paresis of the limbs is possible.

The progressive disease leads to the development of muscle atrophy, changes in joints, and also affects the lower extremities. However, due to the slow progression of the pathology, complete immobilization of the patient does not occur.

Separately, there is syringomyelic syndrome, which is observed with meningitis and anomalies in the structure of the craniovertebral junction.

Syringomyelia, treatment of which is started in a timely manner, does not affect the patient’s life expectancy.

When does the disease appear?

Syringomyelia is a chronic disease with slow progression. It is not uncommon for a long time to pass from the formation of cavities in the spinal canal to the appearance of the first symptoms and diagnosis - up to 25 years.

Often the dynamics of the development of the disease is very slow, there is no sharp increase in symptoms. In half of the cases, the first symptoms of pathology appear in old age against the background of other diseases that are difficult to tolerate in older age (infectious diseases, pneumonia).

Sometimes the patient may not know about syringomyelia and what it is may emerge by chance during examination of other organs.

Very rarely (no more than 7% of the total number of patients) rapid development of pathology is observed. In this case, with syringomyelia, the symptoms increase over four to five years and ultimately lead to the patient’s disability.

Diagnosis of pathology

The diagnosis is made by a neurologist. First, the doctor examines the patient and analyzes complaints. Particular attention is paid to disorders of skin sensitivity and impaired reflexes. The patient is then referred for the following examinations:

MRI of the spine and head;
electroencephalography of the brain;
examination of cerebral vascular tone;
cerebrospinal fluid examination.

A magnetic resonance imaging scan may show changes in the structure of the cerebrospinal fluid. MRI can detect the presence of cavities in the spinal canal. Also, to exclude oncological diseases of the brain, tomography is indicated.

If the joints are affected, an x-ray is indicated, which makes it possible to identify degenerative changes and deformation of the joint capsule.

Treatment of pathology

When treating syringomyelia, the severity of the disease plays an important role. At the initial stages, when the proliferation of glial tissue begins, radiation methods are used in therapy to stop this process. In this case, irradiation occurs in those parts of the spine in which pathologically rapid cell proliferation begins. Irradiated preparations of iodine or phosphorus can also be used for this purpose. When introduced into the body, these substances quickly accumulate and irradiate areas with growing tissue from the inside, allowing you to quickly influence this process.

An important stage of such treatment is to protect the thyroid gland and other organs from destructive effects. For this purpose, additional drugs are used.

Drug treatment is prescribed by a neurologist. This therapy includes the following medications:

vitamin and mineral complexes;
neuroprotectors;
dehydrating drugs;
painkillers.

Drugs are often prescribed to improve the passage of impulses along nerve fibers. For maximum effect, the use of such drugs in conjunction with physiotherapeutic methods, for example, UHF, is indicated.

Medication methods do not allow you to get rid of the cavities that have formed. This therapy is recommended to stop the progression of the disease, and is therefore used in the initial stages and as supportive measures in patients with syringomyelia.

The resulting cavities in the spinal canal cannot be cured with medication. For this purpose, surgical treatment is used. Shunting is usually practiced.

Forecast

It is impossible to completely get rid of syringomyelia. However, this disease in most cases does not affect the patient’s life expectancy or ability to work.

It is important to prevent the progression of the pathology and regularly see a doctor. For this purpose, the doctor will prescribe drug maintenance therapy, which should be followed throughout life, repeating the course of treatment on average twice a year. Physiotherapeutic methods and exercise therapy may also be prescribed.

The danger with syringomyelia is common household injuries and burns. Due to impaired sensitivity, the patient may not notice the damage, which can lead to infection. A feature of the disease is the immunity of some areas of the skin to critical temperatures, so the patient should be prepared for the fact that he may not be able to recognize the danger in time and suffer a serious burn or frostbite of the skin.

If the progression of the disease is stopped in time, syringomyelia does not lead to problems with self-care and practically does not impose restrictions on the patient’s work activity. However, patients themselves must remember that they are not recommended to work with traumatic materials or in conditions of increased danger, since due to impaired sensitivity the patient will not be able to react in time to skin damage.