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Sacral dysgenesis associated with occult spinal dysraphism causing neurogenic bladder dysfunction.

A case of a neurogenic bladder in a 20-year-old man is described. The patient had difficulty in voiding and incontinence, with a history of several urinary infections. Misdiagnoses included stricture and posterior urethral valves. Early treatment included urethral dilation, a transurethral resection and a left ureteral implantation. Throughout this time the neurological examinations were essentially normal. Final diagnosis was sacral dysgenesis with associated occult spinal dysraphism, after the discovery of a small pock mark over the sacrum and an abnormal pelvic x-ray. Urinary diversion was done.

Adult↗

Second-trimester ultrasonographic diagnosis of segmental vertebral abnormalities associated with neurological deficit: a possible new variant of occult spinal dysraphism.

Sonographic evaluation of the fetal spine in a second-trimester, low-risk patient revealed segmentary, low thoracic vertebral abnormalities, including hemi- and butterfly vertebrae, resulting in severe fetal scoliosis with fetal paraplegia and bilateral club-feet. X-ray and magnetic resonance imaging studies of the abortus confirmed the prenatal vertebral findings in addition to rib defects and transection of the spinal cord. We believe that these findings which, to the best of our knowledge, have not been previously reported, represent a new variant of occult spinal dysraphism.

Adult↗

Physical and biochemical characteristics of the human dysraphic spinal cord.

The spinal cords were removed from 29 infants between 17 and 46 weeks gestation, all with various forms of spinal dysraphia. The spinal cords were assessed for weight, length, thickness, size and number of cells, and myelination, and then were compared with 86 control spinal cords. The strongest characteristic of the dysraphic cords was a reduced degree of myelination. Cell size and number generally were appropriate for the weight of the cords. There was a tendency for cord weight, length and thickness to be reduced, though in part this was a reflection of poor over-all bodily growth. In a small group of infants these measurements were increased in comparison with the controls.

Body Water↗

Comparison of high resolution real time ultrasonography and high resolution computed tomography in an infant with spinal dysraphism.

An infant with a lumbosacral spinal subcutaneous and intraspinal lipoma involving the conus medullaris was studied with computed tomography and high resolution real time ultrasonography to determine the extent and location of the disease before operation. The high resolution ultrasonogram demonstrated the abnormality with good detail and the added advantage of real time display of the lack of pulsatile mobility of the neural elements, confirming spinal cord tethering. Spinal high resolution ultrasonography is a noninvasive diagnostic tool in infants with spinal abnormalities and should be an important part of a neurosurgeon's diagnostic support system.

Diagnosis, Differential↗

SPINAL DYSRAPHISM.

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Congenital Abnormalities↗