Updated: 12/25/2021

Meningomyelocele

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  • Snapshot
    • An infant is born in an refugee camp to a starving mother. He has a severe anatomic defect along the spinal tract.
  • Introduction
    • Birth defect in which the spinal canal, meninges, and backbone do not close before birth
      • associated with maternal diabetes and folate deficiency
      • increased AFP in amniotic fluid and maternal serum
      • increased acetylcholinesterase in amniotic fluid
    • Most severe form of dysraphism involving the vertebral column
    • Causes the spinal cord and meninges to protrude from the opening in the infants back
    • Most common type of spina bifida
    • Thought to be caused by low folic acid levels in the mother's diet
  • Epidemiology
    • Incidence of 1/800 in the United States
  • Presentation
    • Symptoms
      • may show partial paralysis
      • sensory deficits
      • loss of bladder or bowel control
      • motor weakness
    • Physical exam
      • protruding spinal cord and meninges from the back
      • club foot may be noted
      • hydrocephalus
      • sacral dimpling
  • IMAGING
    • Pregnancy ultrasound
      • may show herniated sac and incomplete spinal closure
  • STUDIES
    • Prenatal screening
      • monitor folic acid levels in mother
    • Amniocentesis
  • Differential
    • Other spina bifida and neural tube defects
  • DIAGNOSIS
    • Diagnosis based primarily on clinical observation
  • Treatment
    • Prevention
      • prenatal vitamins (specifically, folic acid) prevents development of neural tube disorders
    • Medical management
      • folic acid supplementation for mother
        • in particular in patients on seizure medications
      • prophylactic antibiotics
        • may be indicated for prevention of meningitis and urinary tract infections
    • Surgical intervention
      • surgical repair of the defect
        • indicated in all cases to prevent further herniation
      • ventricular peritoneal shunt
        • may be indicated in patients with hydrocephalus
      • therpeutic abortion
        • may be indicated or preferred in severe cases
  • Complications
    • Scoliosis, foot or ankle deformities, dislocated hips, joint tightness or contractures, permanent present and further future spinal cord paralysis (with rapid pubescent growth period), frequent urinary tract infections, meningitis
  • Prognosis
    • Can usually be surgically corrected
    • Length of life is usually not affected with proper treatment
    • Paralysis is most often irreversible

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Questions (1)

(M3.PD.15.85) A 27-year-old woman presents for a checkup. She is 8 weeks pregnant and has been admitted to the hospital multiple times during her pregnancy for seizures. She has a known seizure disorder but discontinued her valproic acid when she became pregnant. The patient's past medical history is otherwise unremarkable. She does not smoke, drink alcohol, or use any drugs. She generally prefers not to take medications and sees a shaman for her care typically. Given her recent hospitalization, the patient agrees to start carbamazepine. Which of the following is the most appropriate treatment for this patient at this time?

QID: 103108

Folate

29%

(2/7)

Iron

0%

(0/7)

Magnesium

71%

(5/7)

Vitamin B12

0%

(0/7)

Vitamin D

0%

(0/7)

M 11 E

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Evidence (4)
EXPERT COMMENTS (2)
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