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Hydromyelia is a neurological condition characterized by a buildup of fluid inside the central canal of the spinal cord. This puts pressure on the nerves in the spinal cord and leads to neurological symptoms such as weakness in the extremities, difficulty walking, and disordered speech. Patients with this condition need to be evaluated by a neurologist who can pinpoint the area of damage and provide patients with treatment recommendations. Most commonly, hydromyelia is seen in infants and young children.
Hydrocephalus is often linked with hydromyelia, as are some other congenital variations involving the brain. In patients with this condition, the central canal of the spinal cord widens and cerebrospinal fluid (CSF) accumulates inside. This condition is often confused with syringomyelia, which also involves an accumulation of CSF, but on the outside of the central canal, rather than on the inside. Syringomyelia is also usually found in a closed cavity, unlike hydromyelia, which is connected to the fourth ventricle of the brain. The effects of both conditions are similar, however, and often the treatment approaches are comparable as well.
Patients with hydromyelia can develop a variety of symptoms, depending on which nerves are involved. Loss of bladder control, spasticity or paralysis in the limbs, balance problems, numbness, and tingling sensations can all occur. These changes may occur over time or more rapidly. This condition requires medical imaging studies for a diagnosis.
When the spine of a patient with hydromyelia is imaged, the pocket of CSF buildup can be seen in the image. Depending on the location and size of the buildup, a neurologist may recommend several options. One is a wait and see approach, as sometimes this condition resolves on its own. Surgery may also be offered, with a number of different surgical techniques available to manage the condition. A doctor may feel that a patient is not a good candidate for surgery, and suggest analgesia and supportive care to help the patient manage the symptoms.
Parents may find that it is beneficial to discuss the situation with several neurologists if they have a child diagnosed with hydromyelia. Different doctors have different approaches to treatment and may have varying levels of experience, and talking directly to a neurosurgeon can also help people get better informed about surgical treatment options which may be available. Most doctors respect the desire for a second opinion and may even offer a referral to another physician for a patient who is interested in working with another doctor.
If you have discovered that you or someone you know has this condition, I would absolutely seek more than one opinion on how to deal with it.
Even if the first doctor says what you want him to say, whether that is that you should have surgery or that you should not have surgery, I would still double check with someone else, or even more than one someone else.
People don't realize how very difficult surgery on the spinal cord actually is. It is not just one single strand of nerves, but looks more like fine spaghetti, and if even a single strand is damaged, you could pay for it for the rest of your life.
Even though it goes against the grain to disagree with a doctor, I would make an exception in this case and make sure you have as much detail as possible about all the treatments available to you.
One of the most incredible cases of hydrocephalus I've ever heard of was a man who went to the doctor because he had discovered a weakness in his leg and it turned out that he had had hydrocephalus for a long time. So long, in fact that it had gradually taken out most of the upper reaches of his brain, so that he was functioning with only a small strip of it left.
But it had happened so gradually that the remaining brain had compensated and the man was able to continue functioning in society, even having a family and raising children and holding down a job.
In fact he might not have even noticed his condition if not for
the leg weakness.
It's just amazing what the human brain is capable of. I know that generally when people say "we only use 10% of our brain" they aren't actually right, but in this man's case they aren't far off the mark!
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