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
QUESTIONS 1 of 1 1 Previous Next (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 Type & Select Correct Answer 1 Folate 17% (1/6) 2 Iron 0% (0/6) 3 Magnesium 83% (5/6) 4 Vitamin B12 0% (0/6) 5 Vitamin D 0% (0/6) M 11 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic