Occult spinal dysraphia - a case report

One of the most complex and most difficult congenital anomalies is spina bifida. Peter Van Forest was the first one who noticed this anomaly in 1587, and Recklinghausen, in 1886, classified spina bifida to types and suggested surgical procedures for its management. Earlier name, spina bifida, is currently more and more replacing with a term ?defect of neural tube? (NTDs), or even more, ?spinal dysraphia?. Anomaly can appear at any level of spinal cord (cervical, thoracal, lumbar and sacral) and posterior localization is more often than the anterior one. Contrary to the open spinal dysraphism that can be perceived immediately, closed spinal dysraphism is very deceiving anomaly, and therefore, it must be treated properly as soon as it is diagnosed. Because of its seclusion, the term usually used is ?occult spinal dysraphism (OSD)?. The incidence of this anomaly is unknown, but it has been reported that it is more common among female children. Etiology of OSD is also unknown, but some of its risk factors are as follows: previous pregnancy with NTD, partner with NTD, type 1 diabetes mellitus, usage of anticonvulsives, a lack of folates in mother?s nutrition. Prenatal diagnose of OSD is practically impossible. Skin changes, orthopedic, urological and neurological problems, suggest considering this complex anomaly. X-ray, ECHO, MRI, as well as neuropsychological examination corroborate diagnosis. At the same time, the diagnosis (once it is confirmed) represents the indication for neurosurgical treatment.

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Occult Spinal Dysraphism: A Challenge in Pain Management

January 2018 - Pain Physician ◽

10.36076/ppj/2015.18.e225 ◽

2015 ◽

Vol 2;18 (2;3) ◽

pp. E225-E228

Author(s):

Frederic J Gerges

Keyword(s):

Pain Management ◽

Spina Bifida ◽

Spinal Dysraphism ◽

Lumbar Radiculopathy ◽

Occult Spinal Dysraphism ◽

Case Scenario ◽

Vascular Abnormalities ◽

The Central Nervous System ◽

Radicular Symptoms ◽

Clinical Dilemma

Spina bifida is a common birth defect affecting the central nervous system and represents a group of neural tube defects caused by congenital dysraphic malformations of the vertebral column and/or spinal cord. The anatomy in these patients is challenging and includes structural and vascular abnormalities including arteriovenous malformation or fistulae, and fatty substitution of paravertebral tissues. A magnetic resonance image (MRI) is needed for management of patients with lumbar radiculopathy and clinical features suspicious of occult spinal dysraphism. Risks and benefits of lumbar epidural steroids should be discussed comprehensively with those patients and in the best case scenario be avoided. Occult spinal dysraphism poses a clinical dilemma for interventional pain specialists managing those patients with lumbar radiculopathy. We report a case of occult spinal dysraphism discovered following the development of post-traumatic radicular symptoms. Key words: Occult spinal dysraphism, spina bifida, lumbar radiculopathy, pain, pain management, physical findings

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Bone Measures by Dual-Energy X-Ray Absorptiometry and Peripheral Quantitative Computed Tomography in Young Women With Type 1 Diabetes Mellitus

Journal of Clinical Densitometry ◽

10.1016/j.jocd.2020.05.009 ◽

2020 ◽

Author(s):

Hongyuan Jiang ◽

Dale L. Robinson ◽

Alison Nankervis ◽

Suzanne M. Garland ◽

Emma T. Callegari ◽

...

Keyword(s):

Diabetes Mellitus ◽

Computed Tomography ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Young Women ◽

Quantitative Computed Tomography ◽

Peripheral Quantitative Computed Tomography ◽

Dual Energy ◽

X Ray

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Spectrum of skin changes secondary to insulin injections in Type 1 diabetes mellitus patients

Journal of the European Academy of Dermatology and Venereology ◽

10.1111/jdv.12068 ◽

2013 ◽

Vol 27 (10) ◽

pp. 1321-1323 ◽

Cited By ~ 3

Author(s):

G.U. Sawatkar ◽

A.J. Kanwar ◽

S. Dogra ◽

S.K. Bhadada ◽

D. Dayal

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Skin Changes

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The Mermaid Malformation: Cloacal Exstrophy and Occult Spinal Dysraphism

Neurosurgery ◽

10.1227/00006123-199106000-00008 ◽

1991 ◽

Vol 28 (6) ◽

pp. 834-843 ◽

Cited By ~ 48

Author(s):

Alan R. Cohen

Keyword(s):

Spina Bifida ◽

Spinal Dysraphism ◽

Radiographic Examination ◽

Developmental Defect ◽

Pathological Anatomy ◽

Occult Spinal Dysraphism ◽

Cloacal Exstrophy ◽

Neurological Evaluation ◽

Terminal Myelocystocele

Abstract Five infants with cloacal exstrophy underwent neurological evaluation and radiographic examination of the caudal spine shortly after birth. Each was found to have occult spinal dysraphism. Four had terminal myelocystoceles, and one had a lipomyelomeningocele. Pathological anatomy was confirmed during surgery for the release of the tethered spinal cords. The striking association between cloacal exstrophy and occult spinal dysraphism suggests a common developmental defect in the caudal pole of the embryo. A hypothesis is offered to explain this association. Terminal myelocystocele and lipomyelomeningocele appear to be part of a continuum of lesions associated with skin-covered spina bifida.

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A rare case of thoracic myelocystocele associated with type 1 split cord malformation with low lying tethered cord, dorsal syrinx and sacral agenesis: Pentad finding

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.143209 ◽

2015 ◽

Vol 6 (01) ◽

pp. 087-090 ◽

Cited By ~ 1

Author(s):

Dipanker Singh Mankotia ◽

Guru Dutta Satyarthee ◽

Bhawani Shankar Sharma

Keyword(s):

Spina Bifida ◽

Surgical Management ◽

Rare Case ◽

Clinical Presentation ◽

Spinal Dysraphism ◽

Tethered Cord ◽

Split Cord Malformation ◽

Rare Form ◽

Sacral Agenesis

ABSTRACTMyelocystocele is a rare form of spinal dysraphism. Thoracic myelocystocele is still rarer. The occurrence of thoracic myelocystocele associated with type-1 split cord malformation, low lying tethered cord, dorsal syrinx and spina bifida is extremely rare. Clinical presentation of such a rare case and an early surgical management is discussed briefly.

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Prevalence and Association of Occult Spinal Dysraphism with Anorectal Malformation

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.01.11521 ◽

2021 ◽

Vol 104 (1) ◽

pp. 114-122

Keyword(s):

Anorectal Malformation ◽

Spinal Dysraphism ◽

Screening Method ◽

Tethered Cord ◽

Occult Spinal Dysraphism ◽

X Ray ◽

Urethral Fistula ◽

Vestibular Fistula ◽

Higher Types ◽

Magnetic Resonance Imaging Mri

Background: Anorectal malformation (ARM) is associated with occult spinal dysraphism (OSD). The guideline for screening for OSD in patients with ARM is still controversial. Objective: 1) To evaluate the prevalence of OSD in each type of ARM and to elucidate which types of ARM should be screened for underlying OSD. 2) To compare the methods used in radiologic screening for OSD, such as plain lumbosacral X-ray, spinal ultrasound (U/S), and spinal magnetic resonance imaging (MRI). Materials and Methods: The medical records of all patients with ARM treated at Siriraj Hospital between 2006 and 2016 were reviewed. Spinal dysraphism screening with lumbosacral X-ray, U/S, or MRI were performed depending on the surgeon’s request. Associated urinary tract anomalies were noted. Data of the surgical treatments, outcomes, and complications of treatments were collected. Results: Among the 204 ARM patients treated, 150 patients were screened for OSD, involving 150 lumbosacral X-ray, 65 U/S, and 39 MRI. The prevalence of OSD (n=33) in all types of ARM was 16.2%. The higher types of ARM had higher prevalence of OSD, except for vestibular fistula (20.5%). The prevalence of OSD in cloaca malformation, rectobladder neck fistula, rectoprostatic urethral fistula, rectobulbar urethral fistula, and perineal fistula were 28.6%, 33.3%, 16.7%, 12.5%, and 9.8%, respectively. Lumbosacral X-ray had a sensitivity of 51.7% and was not a good screening method. Sixteen of 65 U/S revealed OSD (24.6%). Tethered cord and syringomyelia were noted in nine and seven, respectively. Spinal MRI (n=39) revealed 27 OSD (69.2%) comprising 16 tethered cords, 12 spinal lipoma, and 10 syringomyelia. ARM associated with KUB anomalies had a statistically significant correlation with OSD. In 33 OSD, 17 patients (51.1%) were operated on. Fourteen received untethering spinal cord, while five had intradural lipoma excised. Conclusion: Patients with ARM had a high prevalence of OSD and should be screened for. U/S is the first-line method. MRI is strongly recommended in cloaca malformation, rectobladder neck fistula, rectoprostatic urethral fistula, vestibular fistula, and all ARM associated with KUB anomalies. Other types of ARM should be screened by MRI if feasible. Keywords: Spinal dysraphism, Tethered cord, Anorectal malformation

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Pulmonary Tuberculosis Screening in Patients with Diabetes Mellitus

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.2478/rjdnmd-2019-0017 ◽

2019 ◽

Vol 26 (2) ◽

pp. 159-168

Author(s):

Adela-Gabriela Firănescu ◽

Maria Moța

Keyword(s):

Diabetes Mellitus ◽

Pulmonary Tuberculosis ◽

X Ray ◽

Type 2 Dm ◽

Chest X Ray ◽

Latent Tb ◽

Latent Tb Infection ◽

Type 1 Dm

Abstract Background and aims: Diabetes mellitus (DM) is a risk factor for pulmonary tuberculosis (TB), increasing the risk of progression of latent tuberculosis infection (LTBI) to active TB threefold, threatening the TB control, especially in developing countries. The aim of this study was to assess active and latent TB infection frequency in patients with DM. Material and methods: There were enrolled in this study 503 adult DM patients. Active TB screening was performed through anamnestic data, clinical examination and chest X-ray and latent TB infection screening was evaluated using the tuberculin skin tests (TST). Results: A number of 63 (12.5%) patients had type 1 DM and 440 (87.5%) had type 2 DM. Personal history of TB was present in 21 (4.2%) subjects, 5 (8.1%) with type 1 DM and 16 (3.6%) with type 2 DM. The TST was positive in 258 (51.5%) patients and 54 (10.7%) presented cough for more than two weeks at the time of examination. The chest X-ray revealed suggestive lesions for active TB in 4 (1%) subjects and lesions of inactive TB in 90 (22.4%) subjects. Conclusions: TB screening must receive proper attention in patients with DM, being essential for diagnosis in those with nonspecific symptoms.

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Effects of electrotherapy in treatment of neurogenic bladder in children with occult spinal dysraphism

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0910502c ◽

2009 ◽

Vol 137 (9-10) ◽

pp. 502-505 ◽

Cited By ~ 1

Author(s):

Dragana Cirovic ◽

Ivana Petronic ◽

Dejan Nikolic ◽

Radivoj Brdar ◽

Polina Pavicevic ◽

...

Keyword(s):

Spina Bifida ◽

Neurogenic Bladder ◽

Combined Therapy ◽

Statistical Significance ◽

Spinal Dysraphism ◽

Bladder Capacity ◽

Occult Spinal Dysraphism ◽

Enuresis Nocturna ◽

Transcutaneous Electric Nerve Stimulation ◽

Urodynamic Parameters

Introduction Neurogenic bladder can develop as a result of various degrees of neurogenic lesion in spina bifida. The degree of bladder dysfunction depends on the level and type of spina bifida. Due to results upon complete diagnostic protocols, treatment options are applied. Objective Comparison of therapy results of patients with occult spinal dysraphism with neurogenic bladder that under-went medicamentous therapy and medicamentous with electrotherapy treatment. Methods We had 49 patients with neurogenic bladder that were treated at the University Children's Hospital in Belgrade in the period 2003-2008. The first group of children received medicamentous therapy and the second group received medicamentous therapy with transcutaneous electric nerve stimulation. In both groups we evaluated 4 symptoms: daily enuresis, enuresis nocturna, urgency and frequency and 4 urodynamic parameters: lower bladder capacity, unstable contractions and residual urine and detrusor sphincter dyssynergia. Follow-up urodynamic evaluation was done after 3, 6 and 12 months respectively. Results Our findings pointed out a high statistical significance of improvement in all evaluated urodynamic parameters of neurogenic bladder (predominantly in bladder capacity) in the group of children with combined therapy as well in resolution of symptoms (predominantly enuresis nocturna, urgency and frequency). Conclusion Combined therapy is more efficient in treatment of children with neurogenic bladder. Electrotherapy is non-invasive, easily applicable and has had a significant place in treatment of children with dysfunctional voiding.

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