Spina Bifida Flashcards
Max acceptable bladder pressure
40 cm H20
When to do surgery for scoli in spina bifida
50 degrees
Meningomyelocele
herniation of meninges and neural elements – most common
Associated with hydrocephalus and Chiari type 2
75% lumbosacral
Nerve we can feel related to bladder
Somatic nerves via pudendal, S2-S4 innervate the skeletal muscle component of the external urethral sphincter, contract during fill, relax during emptying.
Worst outcome of Chiari type II
Respiratory compromise
Impaired hand function
Lower cranial nerve function
Closed forms of Neural Tube Defects
encephalocele meningocele iniencephaly lipomeningocele sacral genesis occult spinal dysraphism
What level in spina bifida have most hip disloc
L3 based on muscle imbalance of hip flex and adduction present, other opposing do not
Environmental occupational increase in NTD
painters, agriculture, industrial process workers, healthcare, transportation (solvents)
How much does 4 mg/day help
Reduces risk by 70%
Folic acid supplementation
All women childbearing: 400 micrograms/day
Women w spina bifida or prior NTD preg 4 mg (day 1 to 3 months)
High risk pregame’s (valproic acid or diabetes) 4 mg/day
What is spina bifida occulta
bony defect with no herniation of meninges or nerves
CAN have tethered cord
Effect of folic acid supplementation in grains in USA
4,000 to 3,000 NTD per year
How many kids with Spina Bifida has tethered cord
Almost all (not all symptomatic)
Calcium supplement Spina bifida
500 mg age 1-3
800 mg 3-8
1,300 mg after
What does folate do
cofactor for the enzymatic process involved in purine and pyrimidine synthesis and facilitates the transfer of methyl groups during the metabolism of methionine and homocysteine
Are L4 and L5 spina bifida levels ambulators
Yes, by 4 years
CNS malformation associated with NTDs
Spinal Cord tethering
Arnold -Chiari malformations
Hydrocephalus
Forebrain abnormalities (that cause decreased cognition)