A Newborn Male With a Saclike Lesion: Osmosis USMLE Study Question

November 27, 2020

This is a classic presentation of spina bifida, an incomplete closure of the neural tube during the first month of embryonic development. Spina bifida occulta is a mild form in which spinal cord splits are so small they may not even protrude. Meningocele is characterized by mild symptoms (including the fluid-filled sac at the site of defect), but the nervous system is unaffected.

In this case, the patient has myelomeningocele, a severe form of spina bifida in which portions of meninges and spinal cord protrude through the defect. Symptoms include dyspnea, paralysis of the lower extremities, and bladder/bowel incontinence. Patients with spina bifida are at an increased risk of latex allergy, meningitis, hydrocephalus, and tethered spinal cord. Options for treatment/management of spina bifida include:

  • Surgical intervention within the first few days of life

  • Intrauterine surgery

  • Protective devices and safe handling

  • Ventriculoperitoneal shunt, if evidence of hydrocephalus is present

  • Prophylactic antibiotics

  • Abortion, which may be considered in certain circumstances, depending on the hospital location and guidelines and the mother's preference

The standard treatment is surgical intervention after delivery. This is because significantly increased risk to both the child and mother if surgery is performed during pregnancy.

Major Takeaway: Myelomeningocele, a severe form of spina bifida, is characterized by a protruding saclike lesion on the lower back of a neonate. Surgical intervention within the first few days of life is the best treatment for a baby who presents with myelomeningocele.

Read more about spina bifida.


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