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Incidence of MDS in general population?
For mother with one MDS?
For pt with MDS?
1:1000
1:20-50
1:40
Prevention?
400 micrograms of folic acid in all child bearing women decreases incidence 50%
What is the difference between meningocele, myelomeningocele, lipomyelomeningocele?
What is most common?
Meningocele occurs when just the meninges but no neural elements extend beyond the confines of the vertebral canal
Myelomeningocele, neural tissue, either nerve roots or portions of the spinal cord, has evaginated with the meningocele
3. lipomyelomeningocele denotes that fatty tissue has developed with the cord structures and both are extending with the protruding sac.
Myelomeningocele accounts for more than 90% of all open spinal dysraphic states
Level of spine involved from most to least common?
What is the associated abnormality if CSF is leaking?
In 85% of affected children there is an associated Arnold-Chiari malformation, in which the cerebellar tonsils have herniated down through the foramen magnum, obstructing the fourth ventricle and preventing the cerebrospinal fluid from entering the subarachnoid space sur- rounding the brain and spinal cord.
Is the neurologic lesion predictable based on spinal level?
Variable, depending on what neural elements, if any, have everted with the meningocele sac. The bony vertebral level often provides little or no clue to the exact neurologic level or lesion produced
Features of UMN lesion?
Overactive detrusor, exaggerated sacral reflexes, absence of voluntary control over sphincter function, DSD, and no EMG evi- dence of denervation potentials in the sphincter.
Bladder tends to be trabeculated with a closed bladder neck on VCUG or US
Features of LMN lesion?
Acontractile detrusor and partial or complete denervation of the external urethral sphincter with diminished or absent sacral reflexes may be seen.
Bladder is usually small and smooth walled with an open bladder neck
Neonatal assessment? Normal bladder capacity in neonate?
Normal is 10 to 15 mL; therefore, a residual urine volume of less than 5 mL is acceptable. Urinalysis and culture, serum creatinine determination, and careful neurologic examination of the lower extremities.
VCUG and renal US
What percentage of neonates has abnormal GU tract on imaging?
15-20%
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