13. What are the clinical features of spina bifida occulta?
Correct answer: This is usually an incidental finding noted on X-ray. When overlying skin changes (dimple, hair tuft, lipoma, sinus) are present, the cord beneath may be tethered to the skin by a fibrous band, and, as the child grows…
12. What should the astute clinician look for in the overlying skin in the case of spina bifida?
Correct answer: Tuft of hair; a dimple; an overlying lipoma.
11. Why is does hydrocephalus almost always coexist with a myelomeningocele?
Correct answer: This is because of an Arnold–Chiari malformation, in which the cerebellar tonsils descend below the foramen magnum with consequent obstruction of the cerebrospinal fluid pathway.
10. What are the clinical features of spina bifida?
Correct answer: These defects are particularly common in the lumbosacral area, although any part of the spine may be involved. There may be an associated overlying lipoma, tuft of hair or skin dimple, which may be an important clue to…
9. What has been the result of antenatal screening for spina bifida?
Correct answer: The number of infants born with severe spinal abnormalities has, in consequence, greatly declined.
8. How can spina bifida be screened for antenatally?
Correct answer: Antenatal screening (presence of high levels of ∝-fetoprotein in the amniotic fluid and ultrasound) enables a high degree of accuracy in intrauterine diagnosis of neural tube defects, and gives the opportunity for termination of the pregnancy.
6. What is a myelocele?
Correct answer: Failure of fusion of the neural tube; an open spinal plate occupies the defect as a red, granular area weeping cerebrospinal fluid from its centre.
5. What is a myelomeningocele?
Correct answer: Neural tissue (the cord or spinal roots) protrudes into, and may be adherent to, the meningeal sac.
4. What is a meningocele?
Correct answer: A cystic protrusion of the meninges through a posterior vertebral defect without nervous tissue involvement.
