. A treatise on the nervous diseases of children, for physicians and students. esthere is a narrow opening betweenthe sac and the spinal canal. Attimes there is a complete constric-tion at this point, giving rise toan ordinary cystic formation whichmay contain some of the spinalstructures that have been separatedfrom the main contents of the spi-nal canal. Symptoms. — The chief symp-toms are those of increased press-ure in the spinal and cranial cavi-ties, and such as point to a directinterference with the functions ofthe spinal cord. Children withspina bifida are often poorly devel-oped, and
. A treatise on the nervous diseases of children, for physicians and students. esthere is a narrow opening betweenthe sac and the spinal canal. Attimes there is a complete constric-tion at this point, giving rise toan ordinary cystic formation whichmay contain some of the spinalstructures that have been separatedfrom the main contents of the spi-nal canal. Symptoms. — The chief symp-toms are those of increased press-ure in the spinal and cranial cavi-ties, and such as point to a directinterference with the functions ofthe spinal cord. Children withspina bifida are often poorly devel-oped, and mentally deficient. Ifthe child lives long enough it pre-sents spastic or flaccid paralysis ofthe lower extremities with anaesthesia and with or with-out atrophy. Talipes varus is frequent. Remak describeda form of club-foot associated with spina bifida, differ-ing from congenital club-foot. The child is late in learn-ing to walk and has little or no control over thesphincters of the bladder and rectum. Ectopia of thebladder and other viscera, defective development of the. Fig. 102.—Child of Seven Years,with Spina Bifida and Deform-ity of the Feet. 390 THE NERVOUS DISEASES OF CHILDREN. lower extremities, are frequent complications of spinabifida. Diagnosis.—The condition is easily recognized ; it is tobe differentiated from congenital and other tumors whichoccur often enough in the lumbo-sacral region and may beconnected either with the substance of the cord or with thespinal membranes. Fibroma, sarcoma, myxoma, hygroma, and echinococ-cus cysts are the forms of tumor which occur common-ly in this region. It is of importance to decide whetherthe sac contains nerve structures or fluid only. An explo-ratory puncture with a needle (attached to an electric bat-tery) will help to clear up the point. The course and prognosis of spina bifida will vary muchaccording to the extent of the hernia ; in some instances,the sac ruptures before or very soon after birth ; thesecases are in
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