Syringomyelia and ALS

[GrtWhtNrth]

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I was doing a practice test and came accross the following:

A patient has hyporeflexia in the upper extremities and hyperreflexia in the upper extremities. Narrowed it down to syringomyelia and ALS. Does anyone know if ALS could cause these symptoms? Thanks for the help in advance.

 

[cleansocks]

Yes ALS could do that but it's classic for advanced syringomyelia as the syrinx occurs most frequently in the cervical region. It can eventually expand both anteriorly as well as laterally (beyond the ventral white commissure) to compress the anterior horns producing hyporeflexia in the upper extremities and cortical spinal tract producing hyperreflexia in the lower extremities.

 

[GrtWhtNrth]

Cool, thanks,

I was just thrown off cause in the question there was no mention about lost of pain and temperature sensation in the capelike pattern below the syrinx. Only the motor aspects. Thanks for your reply!

 

[Scaredshizzles]

Was that the asnwer? because that alone sounds like ALS to me, the tropism for motoneurons and I assume you meant hyporeflexia in the upper extremities and hyperreflexia in the LOWER extremities...which is consistent with ALS which tends to effect upper levels of the spinal cord first. Without mention of the anterolateral systems or any other symptoms, I would put ALS as a top choice.

 

[GrtWhtNrth]

Not sure what the answer was, it was one of those online practice exams from the NBME.

 

[fakin' the funk]

I was doing a practice test and came accross the following:

A patient has hyporeflexia in the upper extremities and hyperreflexia in the upper extremities. Narrowed it down to syringomyelia and ALS. Does anyone know if ALS could cause these symptoms? Thanks for the help in advance.

There's no way a syrinx impinges on the motor tracts without being preceded by ventral white commissure symptoms.

Motor only? Go with ALS 👍

 

[Army DOC DO]

ALS is marked with hyporeflexia and fasciculations throughout, because it is a lower motor neuron ds. A syrnx is a upper motor neuron issue and will have hyperreflexia, but you say it had hyper and hypo reflexia in the upper extermities?.. Its either one or the other!
If it was hypo reflexia in the upper extremities and hyper in the lower I would say Syrinx, if it was hypo in the lower and upper I would say ALS

 

[Taus]

ALS is marked with hyporeflexia and fasciculations throughout, because it is a lower motor neuron ds. A syrnx is a upper motor neuron issue and will have hyperreflexia, but you say it had hyper and hypo reflexia in the upper extermities?.. Its either one or the other!
If it was hypo reflexia in the upper extremities and hyper in the lower I would say Syrinx, if it was hypo in the lower and upper I would say ALS

just an fyi...ALS is an upper and lower motor neuron dz....a syrinx can have elements of both depending on how large it is

I never saw a question stem anywhere that asked you to differentiate b/w these 2 disorders w/o mentioning something about pain and temp sensation

 

[Army DOC DO]

just an fyi...ALS is an upper and lower motor neuron dz....a syrinx can have elements of both depending on how large it is

I never saw a question stem anywhere that asked you to differentiate b/w these 2 disorders w/o mentioning something about pain and temp sensation

what I was saying ALS has mostly LMN issues, jeez so touchy. also his question stem he wrote says that it was hypo and hyper in the upper extremity... so either it was typed incorrectly or it was a bunk question,... you didn't seem to jump all over that and correct that!

 

[Scaredshizzles]

No, ALS really does involve both UMN and LMN, but the pattern can vary and one can come before the other. The most common early presentation is with involvement of the cervical spinal cord, and if you have both UMN and LMN tracts effected there, you would expect hyporeflexia of the arms and hyperreflexia in the legs do to damage to descending UMN tracts in the spinal cord. But you won't see that in any review book, but I think if only motor signs were described, it is a safe bet that it is ALS. If the answer is otherwise, I would say it is a bad question anyway. While test questions may not give a complete textbook case, they rarely are inconsistent with the textbook case, because otherwise it would make it impossible.

 

[Taus]

what I was saying ALS has mostly LMN issues, jeez so touchy. also his question stem he wrote says that it was hypo and hyper in the upper extremity... so either it was typed incorrectly or it was a bunk question,... you didn't seem to jump all over that and correct that!

relax...it was wrong...got corrected...end of story...

 

[Army DOC DO]

yeah your right end of story, sorry didn't catch anything fishing today... frustrated! sorry have a good one.

 

[evenflowcarter]

on a side note this was on my comlex... interestingly enough, I had never seen the word SYRINX before and was hoping that it did in fact mean syringommyelia.

I lucked out.

 

[GrtWhtNrth]

I was doing a practice test and came accross the following:

A patient has hyporeflexia in the upper extremities and hyperreflexia in the upper extremities. Narrowed it down to syringomyelia and ALS. Does anyone know if ALS could cause these symptoms? Thanks for the help in advance.

Yeah, I did mean hyperreflexia in the lower extremities. Sorry, maybe I should proofread before I post.

Anyway, it sounds like ALS to me from the posts. Cheers for the help guys.