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How Can Be Tight Hamstrings,claw Toes And Spaticity In Children Be Treated ?

Posted on Thu, 19 Apr 2012

Question: I am going out of my mind with worry. My 14 year old son has gone from tight hamstrings to cavovarus foot, claw toes, intoe walking and stiffness and spasticity in the last year. An MRI shows hydromyelia from T4 to T11 with a schrosis node at T11. We left the scans with a paediatric neurosurgeon nearly a week ago and still have not heard anything but it appears he cannot help. What does this mean for my sons future health?

Answered by Dr. Praveen K Nath (30 hours later)

Hello,

I have gone through your son,s history in detail .
He seems to be an autistic child .most of the neurological deterioration in an autism child is secondary to intracerebral hypoxia etc but in your son,s case it might be partially due to hydromyelia in dorsal cord ,which also appears to be congenital . as a neurosurgeon we can,t offer much for spinal recovery as it is due to underdeveloped spinal cord .
You need to depend more on physiotherapy , rehabilitation procedures , accupressure accupuncture ,& at times botox therapy ,baclofen pump &/or minor tendon transfer procedures for better mobility .

Kindly feel free to consult me for any further querry

Dr Praveen k XXXXXXX XXXXXXX consultant neurosurgeon

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Praveen K Nath (3 hours later)

I was of the understanding that hydromyelia may be treated surgically with a shunt, so could you clarify why this may not be the case for my son ? Would his recent deterioration be as a result of a growth spurt and in that case is it likely to stabilise at some point? I worry about the future and I am sure you probably cannot answer this question but is there likelihood of paralysis, bowel and bladder problems, neurological pain and/or breathing difficulties. Is his condition life threatening or life limiting ? Sorry for all the extra questions but we left scans with a neurosurgeon a week ago and he still has not got back to us. Thank you for your help, ongoing support and answering my original question. I hope you can answer my further questions and I can at least have this information to digest before the surgeon gets back to us.

Answered by Dr. Praveen K Nath (20 hours later)

Hi again,

Shunt surgery in hydromyelia has very limited role. This is kept reserved for those cases where either the pressure effect is found or if there is extension of hydromyelia to different levels on repeat serial MRI brain scans. A thorough clinical examination and correlation by a competent neurologist is necessary to decide the need for surgery.

Recent neurological deterioration in your son may be secondary to increasing pressure / size of hydromyelia. It may continue for a while. It may be self limiting in few cases too.

Though hydromyelia in dorsal cord can produce all these complications mentioned by you, it is only seen in a few cases. So whole management actually depend on clinical & radiological correlation .

Hope this answers your queries. If you have additional concerns feel free to write back. I will be glad to address them as well.

Wishing a speedy recovery.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Praveen K Nath (3 days later)

I have the review of the scans from the neurosurgeon. It says: in the spinal cord there are segments of hydromyelia and, to my eye, the overall bulk of the thoracic spinal cord looked a little less than usual. The spinal cord terminates at a normal level. There is no compromise of the spinal canal itself and no evidence of a Chiari malformation. The brain imaging shows apparently structurally normal brain. The ventricular anatomy appears within normal limits. I have to say that I can see no obvious neurosurgical problem here.

Could you explain what this report actually means, and does this eliminate certain conditions ? What could be causing Matthews symptoms which I have described previously ? Could this mean he has a peripheral nerve disease like CMT ?

Answered by Dr. Praveen K Nath (30 hours later)

Dear sir,
Thanks for the follow up.

As per your description of MRI spine report it seems to be more of a case of segmental hydromyelia without any pressure scalloping of spinal canal .

In my opinion best plan of care would be to wait and watch with regular physiotherapy and follow up with a repeat MRI spine after 4 weeks to see any new hydromyelia patches .

Peripheral nerves pathology can be excluded through ELECTROMYOGRAPHY & NERVE CONDUCTION STUDIES of legs & upper limbs.

Continue with the physiotherapy.

Wishing a speedy recovery to your son.

Above answer was peer-reviewed by : Dr. Radhika