Spina bifida

Question 1

Classification of spina bifida?

Answer 1

1. Spina bifida occulta
2. Spina bifida aperta (cystica)
   a) meningocele
   b) myelomeningocele

Question 2

Spina bifida occulta?

Answer 2

(=closed NTDs)
1. covered by skin or
connective tissue
2. without herniation
⭢ spinal cord,
meninges, overlying
skin remain intact

Question 3

Spina bifida aperta (cystica)?

Answer 3

(open NTDs)
Meninges and/ or neural tissue are uncovered

Question 4

Meningocele?

Answer 4

Meninges (without neural tissue) herniate trough the vertebral bone defect.

Question 5

Myelomeningocele?

Answer 5

Meninges and parts of spinal cord herniate trough the vertebral bone defect.

Question 6

Clinical features of spina bifida occulta?

Answer 6

1. often asymptomatic
   (without imaging)
2. lumbar skin dimple
3. collection of fat
4. patch of hair

Question 7

Clinical features of spina bifida aperta?

Answer 7

1. Herniated part is visible
2. motor weakness
3. sensory deficits
4. bladder and bowel
   dysfunction
5. hydrocephalus
6. developmental delays,
   cognitive impairment

Question 8

When and what kind of examinations can we detect spina bifida?

Answer 8

1. during pregnancy
2. ultrasound examination
3. examination of mother’s
   blood
4. amniotic fluid analysis
   for alfa-fetoprotein

Question 9

What can we do if examinations are positive?

Answer 9

1. Termination of
   pregnancy.
2. Continuation of the
   pregnancy.

Question 10

Continuation of the pregnancy?

Answer 10

1. Cesarean delivery and
   antibiotics to prevent
   CNS infection.
2. MRI (or CT scans) to
   evaluate bone defects
   and/ or neural tissue
   lesion.
3. Surgical treatment
4. Long term care may
   involve

Question 11

What included surgical treatment?

Answer 11

1. For myelomeningocele
   fetal surgery (during
   pregnancy) may be
   indicated.
2. For spina bifida aperta
   surgery soon after
   delivery.
3. For spina bifida occulta
   monitoring and possible
   surgery later.

Question 12

What included long term care?

Answer 12

1. Physical therapy
2. Rehabilitation programs
3. Specific treatment of
   neurological disorders

Question 13

What kind of vitamin plays a vital role in the CNS development?

Answer 13

Folic acid (=B9 vitamin)

Question 14

What can cause folate deficiency during pregnancy?

Answer 14

1. Insufficient folate
   supplementation.
2. Drugs that interfere
   folate metabolism.
3. Diabetes mellitus of
   mother.
4. Chromosomal
   aberrations, genetic
   factors in fetus.