Symptoms of syringomyelia
What are the clinical features of syringomyelia?
The classic clinical features are dissociated sensory loss (loss of temperature and pain with intact proprioception) and lower motor neuron weakness (flaccid paralysis, atrophy, fasciculations) at the level of the lesion with upper motor neuron weakness below the level of the lesion.
These symptoms develop because centrally located lesions initially compromise the decussating fibers of the spinothalamic tract, which carry pain and temperature information.
Because of the lamination of the spinal cord, the cervical and thoracic fibers are affected first (if the lesion is in the cervical region), resulting in a “cape” or “shawl” distribution of sensory loss bilaterally.
Dorsal column function is preserved, thus causing the dissociation of sensory loss.
With forward extension of the cavity, anterior horn cells are affected, resulting in atrophy, paresis, and areflexia at the level of the lesion.
If the lesion extends to involve the corticospinal tract, upper motor neuron weakness and hyperreflexia will develop below the lesion.
Lateral extension may also result in an ipsilateral Horner’s syndrome. Neurogenic arthropathies may also develop