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Dr Shaker Ee


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Dr Shaker Ee

  1. 1. Neural Tube Defects <ul><li>By : Dr . Ashraf SHAKER Lecturer of Neurosurgery </li></ul>
  2. 2. When do neural tube defects occur?
  3. 3. Neural Tube Development <ul><li>Normal embryological development </li></ul><ul><ul><li>Neural plate development -18th day </li></ul></ul><ul><ul><li>Cranial closure 24th day (upper spine) </li></ul></ul><ul><ul><li>Caudal closure 26th day (lower spine) </li></ul></ul>
  4. 4. What is Spina Bifida? <ul><li>A midline defect of the </li></ul><ul><li>bone, </li></ul><ul><li>skin, </li></ul><ul><li>spinal column, &/or </li></ul><ul><li>spinal cord. </li></ul>
  5. 5. Clinical Considerations <ul><li>Does the mother generally know she is pregnant when the neural tube is developing? </li></ul><ul><li>(See Tecklin, page 166.) </li></ul>Note this chart illustrates WEEKS of gestation (pregnancy).
  6. 6. Clinical considerations: At what point could health professionals prevent the development of neural tube defects? (See Tecklin, page166.) Consider the role of the PT in health promotion and prevention through education.
  7. 7. Preventive Care <ul><li>T he United States Public Health Service recommends that: &quot; All women of childbearing age in the United States who are capable of becoming pregnant should consume 0.4 mg of folic acid per day for the purpose of reducing their risk of having a pregnancy affected with spina bifida or other neural tube defects.&quot; Folic acid is a &quot;B&quot; vitamin that can be found in such foods as: cereals, broccoli, spinach, corn and others, and also as a vitamin supplement. </li></ul>
  8. 8. Types of Myelodysplasia* <ul><li>Spina bifida occulta </li></ul><ul><li>Lipomeningocele </li></ul><ul><li>Meningocele </li></ul><ul><li>Myelomeningocele = Spina Bifida </li></ul><ul><li>* defective development of the spinal cord </li></ul>
  9. 9. Neurologic pathology <ul><li>Spina bifida occulta </li></ul><ul><li>( occulta = closed) </li></ul><ul><li>A condition involving nonfusion of the halves of the vertebral arches without disturbance of the underlying neural tissue </li></ul>
  10. 10. Neurologic pathology <ul><li>Lipomeningocele </li></ul><ul><li>( lipo = fat) </li></ul><ul><li>lipoma or fatty tumor located over the lumbosacral spine. Associated with bowel & bladder dysfunction </li></ul>Lipomeningocele
  11. 11. Neurologic pathology <ul><li>Meningocele ( cele = sac) </li></ul><ul><li>Fluid-filled sac with meninges involved but neural tissue unaffected </li></ul>
  12. 12. Types of Myelodysplasia <ul><li>Myelomeningocele </li></ul><ul><li>or spina bifida : meninges and spinal tissue protruding through a dorsal defect in the vertebrae </li></ul>
  13. 13. The spinal defect with myelomeningocele
  14. 14. Incidence and Prevalence <ul><li>Incidence </li></ul><ul><ul><li>1/1000 </li></ul></ul><ul><li>Prevalence </li></ul><ul><ul><li>Increased incidence in families of Celtic and Irish heritage (genetic or environmental?) </li></ul></ul><ul><ul><li>Increased incidence in minorities (genetic or environmental?) </li></ul></ul><ul><ul><li>Increased incidence in families </li></ul></ul>
  15. 15. Etiology <ul><li>Neural Tube defects may result from: </li></ul><ul><li>Combination of environmental and genetic causes </li></ul><ul><li>Teratogens – Remember what these are? </li></ul><ul><li>Nutritional deficiencies - notably, folic acid deficiency </li></ul>
  16. 16. Diagnosis and Detection <ul><li>Amniocentesis </li></ul><ul><ul><li>AFP - indication of abnormal leakage </li></ul></ul><ul><li>Blood test </li></ul><ul><li>Maternal blood samples of AFP </li></ul><ul><li>Ultrasonography </li></ul><ul><ul><li>For locating back lesion vs. cranial signs </li></ul></ul><ul><ul><li>(See Tecklin, pages 167-168.) </li></ul></ul>
  17. 17. Prognosis <ul><ul><li>Spina bifida is a: </li></ul></ul><ul><ul><li>static </li></ul></ul><ul><ul><li>non-progressive defect </li></ul></ul><ul><ul><li>with worsening from secondary problems. </li></ul></ul><ul><ul><li>The prognosis for a normal life span is generally good for a child with good health habits and a supportive family/caregiver. </li></ul></ul>
  18. 18. Impairments associated with Spina Bifida <ul><ul><li>Physiological changes below the level of the lesion generally include: </li></ul></ul><ul><ul><li>abnormal nerve conduction, resulting in: </li></ul></ul><ul><ul><li>somatosensory losses </li></ul></ul><ul><ul><li>motor paralysis, including loss of bowel and bladder control </li></ul></ul>
  19. 19. Impairments associated with Spina Bifida <ul><li>Physiological changes below the level of the lesion generally include: </li></ul><ul><li>abnormal nerve conduction, resulting in: </li></ul><ul><ul><li>changes in muscle tone* </li></ul></ul><ul><li>*Note: Muscle tone can range from flaccid to normal to spastic; may have UMN signs with/without true spastic paraparesis; progression of neurologic dysfunction or change in neurologic status most concerning </li></ul>
  20. 20. Impairments associated with Spina Bifida <ul><ul><li>Anatomical changes below the level of lesion: </li></ul></ul><ul><li>musculoskeletal deformities (scoliosis) </li></ul><ul><li>joint and extremity deformities (joint contractures, club foot, hip subluxations, diminished growth of non-weight bearing limbs) </li></ul><ul><li>osteoporosis </li></ul><ul><li>abnormal or damaged nerve tissue </li></ul>
  21. 21. Impairments associated with Spina Bifida <ul><li>Anatomical changes associated with a cervical lesion: </li></ul><ul><li>An enlarged head caused by hydrocephalus </li></ul><ul><li>(“water on the brain” </li></ul>Hydrocephalus
  22. 22. Arnold Chiari Malformation <ul><li>Arnold Chiari type II Malformation: </li></ul><ul><li>cerebellar hypoplasia ( hypoplasia = reduced growth) </li></ul><ul><li>with caudal displacement of the hindbrain through the foramen magnum </li></ul><ul><li>usually associated with hydrocephalus </li></ul>