Neural tubeNeural tubeA tube of ectodermal tissue in an embryo that will give rise to the central nervous system, including the spinal cord and the brain. Lumen within the neural tube is called neural canal which gives rise to the central canal of the spinal cord and the ventricles of the brain.Gastrulation and Neurulation defects (NTDs) are the 2nd-most common type of congenitalCongenitalChorioretinitis birth defects. Neural tubeNeural tubeA tube of ectodermal tissue in an embryo that will give rise to the central nervous system, including the spinal cord and the brain. Lumen within the neural tube is called neural canal which gives rise to the central canal of the spinal cord and the ventricles of the brain.Gastrulation and Neurulation defects can range from asymptomatic (closed NTD) to very severe malformations of the spineSpineThe human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum.Vertebral Column: Anatomy or brainBrainThe part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem.Nervous System: Anatomy, Structure, and Classification (open NTD). Neural tubeNeural tubeA tube of ectodermal tissue in an embryo that will give rise to the central nervous system, including the spinal cord and the brain. Lumen within the neural tube is called neural canal which gives rise to the central canal of the spinal cord and the ventricles of the brain.Gastrulation and Neurulation defects are caused by the failure of the neural tubeNeural tubeA tube of ectodermal tissue in an embryo that will give rise to the central nervous system, including the spinal cord and the brain. Lumen within the neural tube is called neural canal which gives rise to the central canal of the spinal cord and the ventricles of the brain.Gastrulation and Neurulation to close properly during the 3rd and 4th week of embryological development. The most common type of open NTD is meningomyelocele, which involves both the meningesMeningesThe brain and the spinal cord are enveloped by 3 overlapping layers of connective tissue called the meninges. The layers are, from the most external layer to the most internal layer, the dura mater, arachnoid mater, and pia mater. Between these layers are 3 potential spaces called the epidural, subdural, and subarachnoid spaces. Meninges: Anatomy and neural tissue. The etiologies of NTD are multifactorial, ranging from maternal nutrition to genetic determinants. Prenatal diagnosis by ultrasound and maternal α-fetoprotein level is common. Management of open NTDs is mainly surgical.
A neural tubeNeural tubeA tube of ectodermal tissue in an embryo that will give rise to the central nervous system, including the spinal cord and the brain. Lumen within the neural tube is called neural canal which gives rise to the central canal of the spinal cord and the ventricles of the brain.Gastrulation and Neurulation defect (NTD; spinal dysraphismDysraphismTeratogenic Birth Defects) is a congenitalCongenitalChorioretinitis defect in the covering of the central nervous systemNervous systemThe nervous system is a small and complex system that consists of an intricate network of neural cells (or neurons) and even more glial cells (for support and insulation). It is divided according to its anatomical components as well as its functional characteristics. The brain and spinal cord are referred to as the central nervous system, and the branches of nerves from these structures are referred to as the peripheral nervous system.Nervous System: Anatomy, Structure, and Classification, resulting from a failure of the neural tubeNeural tubeA tube of ectodermal tissue in an embryo that will give rise to the central nervous system, including the spinal cord and the brain. Lumen within the neural tube is called neural canal which gives rise to the central canal of the spinal cord and the ventricles of the brain.Gastrulation and Neurulation to close spontaneously during the 3rd or 4th week of embryonic development.
Classification
Open NTD (80% of cases): a midline defect of the vertebral bodies with different degrees of protrusion of the meningesMeningesThe brain and the spinal cord are enveloped by 3 overlapping layers of connective tissue called the meninges. The layers are, from the most external layer to the most internal layer, the dura mater, arachnoid mater, and pia mater. Between these layers are 3 potential spaces called the epidural, subdural, and subarachnoid spaces. Meninges: Anatomy and central nervous systemNervous systemThe nervous system is a small and complex system that consists of an intricate network of neural cells (or neurons) and even more glial cells (for support and insulation). It is divided according to its anatomical components as well as its functional characteristics. The brain and spinal cord are referred to as the central nervous system, and the branches of nerves from these structures are referred to as the peripheral nervous system.Nervous System: Anatomy, Structure, and Classification (CNS)
Defect along the spinal cordSpinal cordThe spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord: Anatomy:
Meningocele: Only the meningesMeningesThe brain and the spinal cord are enveloped by 3 overlapping layers of connective tissue called the meninges. The layers are, from the most external layer to the most internal layer, the dura mater, arachnoid mater, and pia mater. Between these layers are 3 potential spaces called the epidural, subdural, and subarachnoid spaces. Meninges: Anatomy protrudes.
Meningomyelocele: Both meningesMeningesThe brain and the spinal cord are enveloped by 3 overlapping layers of connective tissue called the meninges. The layers are, from the most external layer to the most internal layer, the dura mater, arachnoid mater, and pia mater. Between these layers are 3 potential spaces called the epidural, subdural, and subarachnoid spaces. Meninges: Anatomy and spinal cordSpinal cordThe spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord: Anatomy protrude (most common NTD).
Defect of the craniumCraniumThe skull (cranium) is the skeletal structure of the head supporting the face and forming a protective cavity for the brain. The skull consists of 22 bones divided into the viscerocranium (facial skeleton) and the neurocranium.Skull: Anatomy:
Cranial meningocele: MeningesMeningesThe brain and the spinal cord are enveloped by 3 overlapping layers of connective tissue called the meninges. The layers are, from the most external layer to the most internal layer, the dura mater, arachnoid mater, and pia mater. Between these layers are 3 potential spaces called the epidural, subdural, and subarachnoid spaces. Meninges: Anatomy protrude.
Cranial encephalocele: Both the meningesMeningesThe brain and the spinal cord are enveloped by 3 overlapping layers of connective tissue called the meninges. The layers are, from the most external layer to the most internal layer, the dura mater, arachnoid mater, and pia mater. Between these layers are 3 potential spaces called the epidural, subdural, and subarachnoid spaces. Meninges: Anatomy and brain stemBrain StemThe brain stem is a stalk-like structure that connects the cerebrum with the spinal cord and consists of the midbrain, pons, and medulla oblongata. It also plays a critical role in the control of cardiovascular and respiratory function, consciousness, and the sleep-wake cycle.Brain Stem: Anatomy/cerebellumCerebellumThe cerebellum, Latin for “little brain,” is located in the posterior cranial fossa, dorsal to the pons and midbrain, and its principal role is in the coordination of movements. The cerebellum consists of 3 lobes on either side of its 2 hemispheres and is connected in the middle by the vermis. Cerebellum: Anatomy/cerebral cortexCerebral cortexThe cerebral cortex is the largest and most developed part of the human brain and CNS. Occupying the upper part of the cranial cavity, the cerebral cortex has 4 lobes and is divided into 2 hemispheres that are joined centrally by the corpus callosum. Cerebral Cortex: Anatomy protrude.
Anencephaly: complete failure of the cephalic neural tubeNeural tubeA tube of ectodermal tissue in an embryo that will give rise to the central nervous system, including the spinal cord and the brain. Lumen within the neural tube is called neural canal which gives rise to the central canal of the spinal cord and the ventricles of the brain.Gastrulation and Neurulation to close resulting in fully exposed fetal brainBrainThe part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem.Nervous System: Anatomy, Structure, and Classification (not compatible with life)
Closed NTD: a midline defect of the vertebral bodies without protrusion of the meningesMeningesThe brain and the spinal cord are enveloped by 3 overlapping layers of connective tissue called the meninges. The layers are, from the most external layer to the most internal layer, the dura mater, arachnoid mater, and pia mater. Between these layers are 3 potential spaces called the epidural, subdural, and subarachnoid spaces. Meninges: Anatomy or neural tissue
Without subcutaneous massMassThree-dimensional lesion that occupies a space within the breastImaging of the Breast: spina bifida occulta
With subcutaneous massMassThree-dimensional lesion that occupies a space within the breastImaging of the Breast:
IncidenceIncidenceThe number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from prevalence, which refers to all cases in the population at a given time.Measures of Disease Frequency:
Maternal risk factors during pregnancyPregnancyThe status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth.Pregnancy: Diagnosis, Physiology, and Care:
FolateFolateFolate and vitamin B12 are 2 of the most clinically important water-soluble vitamins. Deficiencies can present with megaloblastic anemia, GI symptoms, neuropsychiatric symptoms, and adverse pregnancy complications, including neural tube defects. Folate and Vitamin B12 deficiency
History of NTD in previous children (5%–10% recurrence with 1–2 affected siblings)
Folic acid-depleting medications (valproic acidValproic acidA fatty acid with anticonvulsant and anti-manic properties that is used in the treatment of epilepsy and bipolar disorder. The mechanisms of its therapeutic actions are not well understood. It may act by increasing gamma-aminobutyric acid levels in the brain or by altering the properties of voltage-gated sodium channels.First-Generation Anticonvulsant Drugs, triamtereneTriamtereneA pteridinetriamine compound that inhibits sodium reabsorption through sodium channels in renal epithelial cells.Potassium-sparing Diuretics, trimethoprimTrimethoprimThe sulfonamides are a class of antimicrobial drugs inhibiting folic acid synthesize in pathogens. The prototypical drug in the class is sulfamethoxazole. Although not technically sulfonamides, trimethoprim, dapsone, and pyrimethamine are also important antimicrobial agents inhibiting folic acid synthesis. The agents are often combined with sulfonamides, resulting in a synergistic effect. Sulfonamides and Trimethoprim, sulfasalazineSulfasalazineA drug that is used in the management of inflammatory bowel diseases. Its activity is generally considered to lie in its metabolic breakdown product, 5-aminosalicylic acid released in the colon.Sulfonamides and Trimethoprim)
Poorly controlled maternal diabetesDiabetesDiabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance.Diabetes Mellitus
Maternal obesityObesityObesity is a condition associated with excess body weight, specifically with the deposition of excessive adipose tissue. Obesity is considered a global epidemic. Major influences come from the western diet and sedentary lifestyles, but the exact mechanisms likely include a mixture of genetic and environmental factors. Obesity
Conception to 3rd week of gestation (gastrulationGastrulationBoth gastrulation and neurulation are critical events that occur during the 3rd week of embryonic development. Gastrulation is the process by which the bilaminar disc differentiates into a trilaminar disc, made up of the 3 primary germ layers: the ectoderm, mesoderm, and endoderm.Gastrulation and Neurulation):
EctodermEctodermThe outer of the three germ layers of an embryo.Gastrulation and Neurulation→ differentiates into neuroectodermNeuroectodermDevelopment of the Nervous System and Face(creating neural plateNeural plateThe region in the dorsal ectoderm of a chordate embryo that gives rise to the future central nervous system. Tissue in the neural plate is called the neuroectoderm, often used as a synonym of neural plate.Gastrulation and Neurulation) → cell replication in neural plateNeural plateThe region in the dorsal ectoderm of a chordate embryo that gives rise to the future central nervous system. Tissue in the neural plate is called the neuroectoderm, often used as a synonym of neural plate.Gastrulation and Neurulation → neural crests + neural fold
MesodermMesodermThe middle germ layer of an embryo derived from three paired mesenchymal aggregates along the neural tube.Gastrulation and Neurulation→ differentiates into notochordNotochordA cartilaginous rod of mesodermal cells at the dorsal midline of all chordate embryos. In lower vertebrates, notochord is the backbone of support. In the higher vertebrates, notochord is a transient structure, and segments of the vertebral column will develop around it. Notochord is also a source of midline signals that pattern surrounding tissues including the neural tube development.Gastrulation and Neurulation→ signals neural fold to enlarge/fuse → neural tubeNeural tubeA tube of ectodermal tissue in an embryo that will give rise to the central nervous system, including the spinal cord and the brain. Lumen within the neural tube is called neural canal which gives rise to the central canal of the spinal cord and the ventricles of the brain.Gastrulation and Neurulation (neurulationNeurulationAn early embryonic developmental process of chordates that is characterized by morphogenic movements of ectoderm resulting in the formation of the neural plate; the neural crest; and the neural tube. Improper closure of the neural groove results in congenital neural tube defects.Gastrulation and Neurulation)
Neural tubeNeural tubeA tube of ectodermal tissue in an embryo that will give rise to the central nervous system, including the spinal cord and the brain. Lumen within the neural tube is called neural canal which gives rise to the central canal of the spinal cord and the ventricles of the brain.Gastrulation and Neurulation “zips up” from the middle outward → cranial (head) and caudal (tail) openings close approximately on days 24 and 28
NeurulationNeurulationAn early embryonic developmental process of chordates that is characterized by morphogenic movements of ectoderm resulting in the formation of the neural plate; the neural crest; and the neural tube. Improper closure of the neural groove results in congenital neural tube defects.Gastrulation and Neurulation: the differentiation and growth of the neural plateNeural plateThe region in the dorsal ectoderm of a chordate embryo that gives rise to the future central nervous system. Tissue in the neural plate is called the neuroectoderm, often used as a synonym of neural plate.Gastrulation and Neurulation into the neural tubeNeural tubeA tube of ectodermal tissue in an embryo that will give rise to the central nervous system, including the spinal cord and the brain. Lumen within the neural tube is called neural canal which gives rise to the central canal of the spinal cord and the ventricles of the brain.Gastrulation and Neurulation during the first trimester of gestation. PNS: Peripheral nervous systemNervous systemThe nervous system is a small and complex system that consists of an intricate network of neural cells (or neurons) and even more glial cells (for support and insulation). It is divided according to its anatomical components as well as its functional characteristics. The brain and spinal cord are referred to as the central nervous system, and the branches of nerves from these structures are referred to as the peripheral nervous system.Nervous System: Anatomy, Structure, and Classification
Most NTDs are discovered during prenatal screeningScreeningPreoperative Care. Open NTDs are evident at birth, but closed NTDs may have more subtle presentations.
Table: Clinical features of major neural tubeNeural tubeA tube of ectodermal tissue in an embryo that will give rise to the central nervous system, including the spinal cord and the brain. Lumen within the neural tube is called neural canal which gives rise to the central canal of the spinal cord and the ventricles of the brain.Gastrulation and Neurulation defects
Name
Description
Clinical features
Myelomeningocele
Spinal cordSpinal cordThe spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord: Anatomy and meningeal herniationHerniationOmphalocele
The higher the lesion in the spineSpineThe human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum.Vertebral Column: Anatomy, the more severe the symptoms:
NeckNeckThe part of a human or animal body connecting the head to the rest of the body.Peritonsillar Abscess: quadriplegiaQuadriplegiaSevere or complete loss of motor function in all four limbs which may result from brain diseases; spinal cord diseases; peripheral nervous system diseases; neuromuscular diseases; or rarely muscular diseases. The locked-in syndrome is characterized by quadriplegia in combination with cranial muscle paralysis. Consciousness is spared and the only retained voluntary motor activity may be limited eye movements. This condition is usually caused by a lesion in the upper brain stem which injures the descending corticospinal and corticobulbar tracts.Locked-in Syndrome
Lumbosacral defect:
Paraplegia/flaccid paralysis
Loss of touch and painPainAn unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons.Pain: Types and Pathways sensations in lower limbs
AnesthesiaAnesthesiaA state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures.Anesthesiology: History and Basic Concepts in perianal area
Bowel + bladderBladderA musculomembranous sac along the urinary tract. Urine flows from the kidneys into the bladder via the ureters, and is held there until urination.Pyelonephritis and Perinephric Abscess incontinence
Meningocele
Meningeal herniationHerniationOmphalocele without spinal cordSpinal cordThe spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord: Anatomy involvement
Covered by skinSkinThe skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue.Skin: Structure and Functions
Encephalocele
MeningesMeningesThe brain and the spinal cord are enveloped by 3 overlapping layers of connective tissue called the meninges. The layers are, from the most external layer to the most internal layer, the dura mater, arachnoid mater, and pia mater. Between these layers are 3 potential spaces called the epidural, subdural, and subarachnoid spaces. Meninges: Anatomy ± brainBrainThe part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem.Nervous System: Anatomy, Structure, and Classification tissue protruding from cranial defect
HydrocephalusHydrocephalusExcessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, intracranial.Subarachnoid Hemorrhage
SeizuresSeizuresA seizure is abnormal electrical activity of the neurons in the cerebral cortex that can manifest in numerous ways depending on the region of the brain affected. Seizures consist of a sudden imbalance that occurs between the excitatory and inhibitory signals in cortical neurons, creating a net excitation. The 2 major classes of seizures are focal and generalized. Seizures
MicrocephalyMicrocephalyA congenital abnormality in which the cerebrum is underdeveloped, the fontanels close prematurely, and, as a result, the head is small. (desk reference for neuroscience, 2nd ed. ).Fetal Alcohol Spectrum Disorder
Major component of the brainBrainThe part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem.Nervous System: Anatomy, Structure, and Classification and skullSkullThe skull (cranium) is the skeletal structure of the head supporting the face and forming a protective cavity for the brain. The skull consists of 22 bones divided into the viscerocranium (facial skeleton) and the neurocranium.Skull: Anatomy is absent.
Stillbirth/early death
Spastic with deafness/blindnessBlindnessThe inability to see or the loss or absence of perception of visual stimuli. This condition may be the result of eye diseases; optic nerve diseases; optic chiasm diseases; or brain diseases affecting the visual pathways or occipital lobe.Retinopathy of Prematurity
Spina bifida occulta
Midline vertebral bodyVertebral bodyMain portion of the vertebra which bears majority of the weight.Vertebral Column: Anatomy fusion defect without protruding dura or neural tissue
Usually asymptomatic
If spinal cordSpinal cordThe spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord: Anatomy is involved (tethered cord syndrome), may develop incontinence, constipationConstipationConstipation is common and may be due to a variety of causes. Constipation is generally defined as bowel movement frequency < 3 times per week. Patients who are constipated often strain to pass hard stools. The condition is classified as primary (also known as idiopathic or functional constipation) or secondary, and as acute or chronic. Constipation, or ataxiaAtaxiaImpairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharynx, larynx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions.Ataxia-telangiectasia
May be accompanied by abnormal overlying skinSkinThe skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue.Skin: Structure and Functions with a hemangiomaHemangiomaA vascular anomaly due to proliferation of blood vessels that forms a tumor-like mass. The common types involve capillaries and veins. It can occur anywhere in the body but is most frequently noticed in the skin and subcutaneous tissue.Imaging of the Liver and Biliary Tract, discoloration, pit, lump, dermal sinus, or hairy patchPatchNonpalpable lesion > 1 cm in diameterGeneralized and Localized Rashes
Serum/amniotic α-fetoprotein (maternal serum α-fetoprotein; MSAFP): high levels at 15–20 weeks of gestation suggestive of NTD, but not diagnostic
Ultrasound: Visualization of defect is 98% specific and can be used to confirm diagnosis (closed NTD may not be detected).
Postnatal imaging
Open NTD: ultrasound commonly used; magnetic resonance imaging (MRI) can be used if further detail required
Closed NTD: ultrasound indicated with following cutaneous signs:
Palpable subcutaneous massMassThree-dimensional lesion that occupies a space within the breastImaging of the Breast
Hairy patchPatchNonpalpable lesion > 1 cm in diameterGeneralized and Localized Rashes overlying spineSpineThe human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum.Vertebral Column: Anatomy
Dermal sinus
Dimples > 5 mmMMMultiple myeloma (MM) is a malignant condition of plasma cells (activated B lymphocytes) primarily seen in the elderly. Monoclonal proliferation of plasma cells results in cytokine-driven osteoclastic activity and excessive secretion of IgG antibodies.Multiple Myeloma deep or > 25 mmMMMultiple myeloma (MM) is a malignant condition of plasma cells (activated B lymphocytes) primarily seen in the elderly. Monoclonal proliferation of plasma cells results in cytokine-driven osteoclastic activity and excessive secretion of IgG antibodies.Multiple Myeloma from anal verge
SkinSkinThe skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue.Skin: Structure and Functions tags or tail-like appendages
Hyperpigmented patchesPatchesVitiligo or deviation of the gluteal cleft
Management
Prenatal
Prevention with folic acid (vitamin B9) supplementation:
Decreases the incidenceIncidenceThe number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from prevalence, which refers to all cases in the population at a given time.Measures of Disease Frequency of NTD by around 70%
Preconception dose: 0.4 mg/day of folic acid for at least 1 month prior to conception and throughout pregnancyPregnancyThe status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth.Pregnancy: Diagnosis, Physiology, and Care
A higher dose (usually 4 mg/day) is indicated for the following:
A previous pregnancyPregnancyThe status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth.Pregnancy: Diagnosis, Physiology, and Care affected by an NTD
Pre-gestational diabetesDiabetesDiabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance.Diabetes Mellitus
Delivery: cesarean section recommended
Postnatal
Closed NTD:
May require no intervention
Ongoing follow-up for lower neurological symptoms (incontinence, constipationConstipationConstipation is common and may be due to a variety of causes. Constipation is generally defined as bowel movement frequency < 3 times per week. Patients who are constipated often strain to pass hard stools. The condition is classified as primary (also known as idiopathic or functional constipation) or secondary, and as acute or chronic. Constipation, difficulty ambulating)
Lecturio Medical complements your studies with evidence-based learning strategies, video lectures, quiz questions, and more – all combined in one easy-to-use resource.
Learn even more with Lecturio:
Complement your med school studies with Lecturio’s all-in-one study companion, delivered with evidence-based learning strategies.
