Spina bifida is diagnosed at birth or in utero. At birth defect on the back of the spine rail protrusion observed with the meninges and neural elements printrun external dural sac.
Physical Exam:The physical examination revealed primary sign is a certain degree of motor and sensory disfucntie. Neurologic lesion is classified according to specific muscle groups. Paralysis may be flaccid or spastic patient. Most patients have a flaccid paralysis below the lesion. 10% of patients have spastic paralysis. Spastic paralysis is associated with adverse prognosis ambulatiei.
Impaired leg:Patients are described as belonging to a particular medical group depending on the lesion:Innervation-group shows the upper chest and neck muscles and motor function variable trunk muscle without voluntary movement of the legs, these patients tend to present a more severe brain damage and cognitive deficits associatedLumbar-group there is a motor activity of flexors and thigh adductors and the absence of extensor movements, and movements abductorilor ankle and knee-Group shows the motor activity of the lower lumbar adductors, flexors and quadriceps, ankle movements and the absence dorsiflexorii variable movements of the ankle plantar flexorsSacral-group shows the movement in all muscles of the thigh and knee, and ankle plantar flexion is variable.
Impaired upper limb:Upper extremity involvement is common. Upper limb spasticity occurs in about 20% of patients with spina bifida. Lack of coordination is associated with Chiari malformation, motor deficits and late development of hand dominance. Children affected shows problems in performing fine motor movements. Installing acute weakness and spasticity may be the result of progressive neurological dysfunction.
Spine deformities:The spine and lower limb deformities are more prevalent in children with myelomeningocele. Multiple factors may be involved including intrauterine positioning, and other birth defects, muscular imbalances, neurological disfucntia progressive abnormal postural habits and lack of movement joints.Spinal deformities or defects can be gained. Anomalies of vertebrae and ribs are associated with early development of scoliosis and kyphosis. Gained is of neuromuscular scoliosis and is associated with muscle imbalance. Increased lumbar lordosis and kyphosis entire column or located in the lumbar region are also observed.Limb deformities are associated with functional level of the lesion.This creates thigh abduction of contracture in external rotation, knee flexion, ankle contractures in the equine.
Short stature:Children with spina bifida are usually of short stature. This phenomenon is correlated with multiple factors comprising: structural disorder spinal column and lower limb contractures, functional level of the lesion neurotrophic impulses that control the lower limbs in appendicular skeletal growth and altered hypothalamic-pituitary axis by hidrocefalus.
Other disorders:Eye Paralysis, swallowing and phonation disorders are signs of abnormal cranial nerbilor dysfunction. These symptoms may be associated with Chiari malformation, or dysplasia hidrocefalusului brain.
Disease progression:The mortality rate for children with spina bifida is increased compared to the general population in the first year of life. For untreated children is 90-100%. Most children die untreated in the first year of life. Death in the second year of life hidrocefalus result from untreated or intracranial infection. The survival rate has improved dramatically after the introduction of antibiotics and development of neurosurgery and hidrocefalusului therapy.Paraplegia with myelodysplasia fucntiei cause motor and sensory impairment in the wound, urinary and bowel dysfunction with, sex.Musculoskeletal complications can be caused by bone and joint deformities progressive, pathological fractures and muscle damage. Other neurologic problems may manifest acute or chronic at birth or later. These include global cognitive dysfunction and motor disfucntia specify. Cognitive dysfunction is correlated with hidrocefalusul.Renal impairment occurs because of problems associated with neurogenic bladder. In spite of advanced therapies neurogenic bladder renal failure is still a leading cause of death in patients with myelomeningocele after the first year of life.
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