SYRINGOMYELIA:
Syringomyelia is the formation of
fluid filled cavity or cyst (syrinx) within the spinal cord that may enlarge
with time causing damage to the spinal cord along with pain, stiffness and weakness
in shoulder, neck, back and legs.
SIGNS
AND SYMPTOMS:
Other symptoms include loss of the
ability feeling to extremes hot and cold especially in hand, headache, facial
pain and numbness, spinal curvature and bowel and bladder function problem. Signs
and symptoms may develop with time with, although sudden onset may occur with
coughing and straining followed by weakness, progressive loss in sensation and
weakness in arms and legs.
COMPLICATIONS:
Complications include scoliosis, motor
movements, chronic pain and Horner syndrome. If condition not treated in time
it may result in injury to spinal cord.
CAUSES:
·
Chiari formation (congenital
abnormality of the brain, in which part of brain tissue may protrude into the
Spinal cord).
·
Spinal cord tumor
·
Spinal cord injuries
·
Inflammation surrounding spinal cord
·
Meningitis
·
Arachnoiditis
·
Tethered spinal cord syndrome
·
Spinal scar tissue
DIAGNOSIS:
Syringomyelia is diagnosed by number
of ways.
·
Magnetic resonance imaging of spine
and spinal cord ( help in beginning stage diagnosis).
·
Electromyography that measures the muscle weakness
·
Cerebrospinal
fluid pressure level and analysis of cerebrospinal fluid by performing lumbar
puncture
·
Computed
axial tomography that scan patient head
to detect any tumor and hydrocephalus
·
Myelogarm
TREATMENT:
Surgery is the only treatment for syrigomyelia.The
main purpose of surgery is to provide more space for the cerebellum at the base
of skull and cervical spine to treat Chiari formation. Sometimes additional operations are
necessary for successful eradication of syringomyelia.
Congenital
syringomyelia may require piece of cervical vertebrae at the site of cavity
formation to be removed.
If
syringomyelia is due to tumor, that result in obstruction then removal
of tumor is necessary.
Drainage
of cavity (drainage just stop progression, have no concern with the elimination
of symptoms associated with syringomyelia) using drainage tubes, catheter and
valve .This system is also called shunt.
Physical
therapy management depends upon severity and impact of the disease.
Neurological examination clears that at which level the syrinx occur. Physical
therapy techniques include following:
I.
RoM
(range of motion) stretching and mobilization of neck and upper limb.
II.
Muscle
strength
III.
Neck
stability
IV.
Balance
V.
Copying
VI.
Occupational
therapy
MEDICATION:
·
To alleviate the pain during syringomyelia single or
combination of medicines are used; but is not concerned with the removal of syringomyelia.
·
Analgesics
are the best ever option to treat syringomyelia. In one pain management plan, an around-the-clock
opiate such as fentanyl patches or Oxycontin are used in conjunction with a
fast-acting opiate.
·
For
classical back pain weak or strong opioids are used such as Tramdol along with
medications that relives neuropathic pain symptoms shooting and stabbing pain
(neurontin).
·
Cortisteroids, such as prednisolone, or non-steroidal
anti-inflammatory drugs may relieve the symptoms but not the deterioration.
Long term use of these drugs is not advised.
·
Anticonvulsants, such as gabapentin have
been successful in some more severe cases, but they may be very
expensive. Pregabalin, amitriptyline and oral opioids (pethidine or
methadone) are alternatives. Methylsulfonylmethane (MSM) is recommended
by some veterinary neurologists as a dietary supplement.
·
Drugs which reduce the production of cerebrospinal
fluid, including proton pump inhibitors such as omeprazole, and the diuretic,
furosemide (Lasix), and spironolactone, may be useful,but clinical data on
their use and effectiveness is lacking. Carbonic anhydrase inhibitors,
such as acetazolamide also serve to decrease the flow of cerebrospinal fluid,
but their adverse side effects of abdominal pain, lethargy, and weakness limit
long term use.
LIFE STYLE CHANGES:
Avoid
such activities that may worse the symptoms of syringomyelia such as
·
Playing
high impact sports such as football.
·
Straining
during bowel movement
·
Excessive
coughing
·
Sky
diving
CHINESE ART OF HEALING
Qigong is a traditional form of Chinese
energy excise and healing art for the body and mind. Qigong is ideal for
re-establishing balance between body and mind and for helping to heal people
who are struggling with chronic degenerative conditions such as paralysis,
diabetes, and syringomyelia.
REFERENCES:
By: Amna Hafeez
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