Spina Bifida
Original Editors -Ally O'Bryan & Stephanie Smith from Bellarmine University's Pathophysiology of Complex Patient Problems project.
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Definition/Description[edit | edit source]
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Prevalence[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
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Associated Co-morbidities[edit | edit source]
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Medications[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
Before Birth
- Alpha-fetoprotein blood test when 16-18 weeks pregnant
- Ultra-sound of the spine
- Maternal amneocentesis- amniotic fluid taken during pregnancy
After Birth
- X-ray, MRI, CT scan
- Meningocele and myelomeningocele are visible on physical exam (path 840)
- Meningocele: protruding sac is transilluminated
- Myelomeningocele: no light shines through the protruding sac
Etiology/Causes[edit | edit source]
Pathology:
- Neural groove develops to form the neural tube around day 20 after conception. In normal development the upper end is supposed to close at day 25 and the lower end is supposed to close at day 27. Three opportunities could cause abnormal closure of the neural tube. If the hyaluronic acid matrix or actin microfilaments have abnormalities early on the neural tube will not close. If an overgrowth occurs over the caudal end the neural tube will not close, but this occurs later in development. The last chance occurs when the glycoproteins that typically hold the cells together during closure fail to adhere the tube together the tube will not properly close. (path 837)
There is no exact reason known for the cause of Spina Bifida, but there are a variety of environmental and gentic factors that may be potential risk factors. [1] [2]
Mother’s nutrition:
- Folic acid- less than 400 µg of folic acid per day- (neuro, spina bifida web)
- Increase of: Vitamin A, valproic acid, solvents, lead herbicides, glycol ether, clomiphene, carbamazepine, aminopterin, alcohol (pathology 837)
Genetic:
- 1.6%-3.3% increase of a child having spina bifida if the parents already have one child with the disease (path 837)
Environmental Factors:
- Radiation and viruses may have an impact on developing fetus (pubmed)
Systemic Involvement[edit | edit source]
Occulta and Meningocele: no neurological dysfunction typically present
Myelomeningocele: permanent neurological and musculoskeletal deficits present (all path 837)
- Neurological: muscle weakness, bowel and bladder problems, seizures, paralysis [3] [1]
- Musculoskeletal: hip dislocation, syringomyelgia[2]
Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports/ Case Studies[edit | edit source]
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Resources
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- Spina Bifida Association: www.spinabifidaassociation.org
- National Institute of Neurological Disorders and Stroke: disorders/spina_bifida/spina_bifida.htm
- March of Dimes: www.marchofdimes.com/
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 Mayo Clinic. Spina Bifida. http://www.mayoclinic.com/health/spina-bifida/DS00417 (accessed 31 March 2012).
- ↑ 2.0 2.1 PubMed Health. Myelomeningocele. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002525/ (accessed 31 March 2012).
- ↑ KidsHealth from Nemours. Spina Bifida. http://kidshealth.org/parent/system/ill/spina_bifida.html (accessed 30 March 2012).