Spina Bifida

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Spina Bifida
2014-03-06 19:13:57
Spina Bifida
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  1. 2 Types of Spina Bifida
    • Aperta: visible or open lesions, more severe
    • Occulta: hidden or non visible lesions
  2. Most Common Forms of Spina Bifida
    • Occulta: mildest form, one or more vertebrae are malformed & covered by a layer of skin 
    • Meningocele: SC develops normally but meninges protrude from a spinal opening
    • Myelomeningocele: severest form, SC & its protective covering (meninges) protrude from an opening in the spine, open to air
  3. Prevention Strategies
    • Folic Acid (Vitamin B)
    • Prenatal Management -- alpha-fetoprotein screening, ultrasound advances, amniotic fluid analysis
  4. Primary Issues
    • Arnold Chiari Malformation
    • Hydrocephalus 
    • Sensory Deficits
    • Motor Paralysis
    • Spasticity (UMN)
    • Neurogenic Bowel/Bladder
  5. Symptoms of Shunt Dysfunction (or the need for a shunt)
    • Changes in speech
    • Malaise
    • Recurring headache
    • Nausea
    • Decreased activity
    • Personality change
    • Change in motor function/neurological status
    • Onset or increase frequency in seizures
  6. Neurogenic Bowel and Bladder
    • Bowel and bladder innervated by spinal segments S2-S4
    • Bowel incontinence, constipation, impaction are presenting issues
    • Management = bowel programs & clean intermittent catheterization on a regular schedule
  7. Tethered Cord
    • Incidence begins after closure, scar tissue
    • Unstable neurology (gait, bowel/bladder, tone)
  8. Syringo(hydro)myelia
    • Fluid filled cyst w/in the cord
    • Related to hydrocephalus
    • Can cause rapid onset/progression of scoliosis
    • Can present as worsening of neurological symptoms as cyst grows and compresses the cord