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2 Types of Spina Bifida
- Aperta: visible or open lesions, more severe
- Occulta: hidden or non visible lesions
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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
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Prevention Strategies
- Folic Acid (Vitamin B)
- Prenatal Management -- alpha-fetoprotein screening, ultrasound advances, amniotic fluid analysis
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Primary Issues
- Arnold Chiari Malformation
- Hydrocephalus
- Sensory Deficits
- Motor Paralysis
- Spasticity (UMN)
- Neurogenic Bowel/Bladder
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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
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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
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Tethered Cord
- Incidence begins after closure, scar tissue
- Unstable neurology (gait, bowel/bladder, tone)
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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
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