L2: NTDs Flashcards
Neural Tube Development
Types of Neural Tube Defects
- Spina Bifida Occulta
- Tethered Cord
- Meningocele
- Myelomeningocele
Incidence of Spina Bifida Occulta
Very mild but Common
Spinal Cord Affection in Spina Bifida Occulta
Very rarely causes disability
How to detect Spina Bifida Occulta?
- x-ray
- investigating a back injury.
Spinal Cord affection in Tethered Cord
The spinal cord could be caught against the vertebrae (Normal cord ends at lower end of L1)
CP of Tethered Cord
- Motor weakness of lower limbs
- Sphincteric problems such as inefficient bladder control.
Incidence of Meningocele
Least common form
Spinal Cord affection in Meningocele
- The nerves are not badly damaged and able to function normally.
- Limited disability is present.
CP of Meningocele
Incidence of Myelomeningocele
Most serious and common
Spinal Cord Affection in Myelomeningocele
- The spinal cord is damaged or not properly developed resulting in motor and sensory deficit.
CP of Myelomeningocele
- The cyst not only contains meninges and CSF but also the nerves and spinal cord.
- Majority have bowel and bladder problems
High Cost of NTDs
Dx of NTDs
- MSAFP
- US
- Amniocentesis
Senseitivity of AFP in detection of NTDs
91% sensitivity in spina bifida
AFP in detection of NTDs
- Normal
AFP in detection of NTDs
- What is Diagnostic Level?
High maternal serum AFP > 2 multiples of median for appropriate week of gestation.
US in detection of NTDs
US in detection of NTDs
- Advantages
- Diffrentiate NTD fron non-neurological causes of elevated AFP e.g. omphalocele
Amniocentesis in detection of NTDs
Amniocentesis in detection of NTDs
- Uses
- Show elevated AFP between 12-15 week earlier than serum AFP
Amniocentesis in detection of NTDs
- Disadvantages
Carries 6% risk of abortion and fetal loss
Amniocentesis in detection of NTDs
- Indications
- Pregnancies subsequent to NTD
- Elevated AFP with Normal US