Hydromyelia: clinical presentation and comparison of modalities of treatment.

The clinical and radiographic features of 60 cases of hydromyelia area discussed. A combination of motor and sensory symptoms and signs is the usual presentation, but pure motor or sensory forms of the disease are not infrequent. Pain and scoliosis are usually associated with a high degree of blockage. A normal spinal fluid protein content in the presence of an enlarged spinal cord is of diagnostic value. Important radiographic clues include widening of the spinal cord without venous stagnation and collapse of the spinal cord visualized with the patient in the upright position. Metrizamide computed tomography is now used routinely, and the contrast agent may at times appear in the dilated central spinal canal. Decompression of the foramen magnum is the treatment of choice in the presence of an associated Arnold-Chiari malformation and is the treatment most likely to succeed. In selected cases, decompressive laminectomy and syringostomy may be indicated. Percutaneous spinal cord puncture is a safe diagnostic-therapeutic procedure which, surprisingly, may afford relief equal to that of more drastic measures. Therefore, percutaneous spinal cord puncture may be an option of therapeutic value in a disorder that is frustrating to treat.