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Myelomeningocele is a severe form of spina bifida. The spinal cord and nerves develop outside the baby’s body. This results in weakness and loss of sensation below the defect. It can interfere with bowel or bladder function or cause fluid to build up in the brain.
Myelomeningocele is a birth defect in which the backbone and spinal canal do not close before birth.
The sacral region (sacrum) is at the bottom of the spine and lies between the fifth segment of the lumbar spine (L5) and the coccyx (tailbone)
Normally, during the first month of a pregnancy, the two sides of the baby's spine (or backbone) join together to cover the spinal cord, spinal nerves and meninges (the tissues covering the spinal cord).
The developing brain and spine at this point are called the neural tube. Spina bifida refers to any birth defect involving incomplete closure of the neural tube in the area of the spine.
Myelomeningocele is a neural tube defect in which the bones of the spine do not completely form. This results in an incomplete spinal canal. The spinal cord and meninges (the tissues covering the spinal cord) protrude from (stick out of) the child's back.
The rest of spina bifida cases are most commonly:--
Spina bifida occulta, a condition in which the bones of the spine do not close but the spinal cord and meninges remain in place and skin usually covers the defect.
Meningoceles, a condition where the tissue covering the spinal cord protrudes from the spinal defect, but the spinal cord remains in place.
Other congenital disorders or birth defects may also be present in a child with myelomeningocele. Hydrocephalus may affect as many as 90% of children with myelomeningocele. Other disorders of the spinal cord or musculoskeletal system may be seen, including syringomyelia (a fluid-filled cyst within the spinal cord) and hip dislocation.
A newborn with this disorder will have an open area or a fluid-filled sac on the mid to lower back.
Symptoms may include:--
Loss of bladder or bowel control
Partial or complete lack of sensation
Partial or complete paralysis of the legs
Weakness of the hips, legs, or feet of a newborn
Other signs and/or symptoms may include:--
Abnormal feet or legs, such as clubfoot
Buildup of fluid inside the skull (hydrocephalus)
Prenatal screening can help diagnose this condition. During the second trimester, pregnant women can have a blood test called the quadruple screen.
This test screens for myelomeningocele, Down syndrome, and other congenital diseases in the baby. Most women carrying a baby with spina bifida will have a higher-than-normal level of a protein called maternal alpha fetoprotein (AFP).
MSAFP is a screening test that examines the level of alpha-fetoprotein in the mother’s blood during pregnancy. This is not a diagnostic test Blood is drawn from veins in the mother’s arm and sent off to a laboratory for analysis.
MSAFP IS most accurate during the 16th to 18th week.
All pregnant women should be offered the MSAFP screening, but it is especially recommended for:--
Women who have a family history of birth defects
Women who are 35 years or older
Women who used possible harmful medications or drugs during pregnancy
Women who have diabetes
Alpha- fetoprotein(AFP) is found in both fetal serum and also amniotic fluid.
This protein is produced early in gestation by the fetal yolk sac and then later in the liver and gastrointestinal tract.
High levels of AFP may suggest the developing baby has a neural tube defect such as spina bifida or anencephaly.
High levels of AFP may also suggest defects with the esophagus or a failure of your baby’s abdomen to close.However, the most common reason for elevated AFP levels is inaccurate dating of the pregnancy.
AFP is a protein normally made by a developing fetus, so it is naturally present in maternal serum and called MSAFP.
When a fetus has spina bifida, the levels of MS-AFP may be higher than usual because it leaks out of the hole in the spine. If a woman's AFP screen comes back abnormal with a high MS-AFP value, she often is at a higher risk for having a baby with spina bifida.
BREACHING OF BLOOD BRAIN BARRIER BY NANO CARBON CAN CAUSE MYELOMENINGOCELE.
BEFORE ADVENT OF CNG/ LPG THIS DISEASE WAS RARE
OUR COLLEGIUM JUDGES ARE PUSHING EVEN VILLAGE WOMEN TO USE LPG CYLINDERS AND PM MODI WANTS TO IMPORT US SHALE GAS FROM HALF WAY AROUND THE PLANET—
WE KNOW WHY !
The BBB is a very selective physical filter within the capillaries that carry blood to the brain.
IN INDIA NEURAL TUBE DEFECTS ARE RARE DUE TO OUR GOTRA SYSTEM
Neural tube defects are birth defects of the brain, spine, or spinal cord. They happen in the first month of pregnancy, often before a woman even knows that she is pregnant.
The two most common neural tube defects is spina bifida where the fetal spinal column doesn't close completely.
Folic acid helps the body break down, use, and create new proteins. It helps form red blood cells and create new DNA, and prevents against heart disease, Alzheimer’s disease, type-2 diabetes and depression.
Most well-known, however, is the fact that folic acid plays a key role with pregnant women by preventing birth and neural tube defects.
As folic acid is water soluble, however, it passes through your body very quickly. By taking folic acid every day, you ensure that you always have it in your system.
Folic acid from food is not associated with any health risk. As a water-soluble vitamin, any significant excess will naturally be eliminated through the body via urine, therefore the body is more adept at using folate.
Foods known to be high in folate include:
Dark leafy greens ( spinach etc)
Fortified whole grains (pasta, cereal, breads etc)
Beans and legumes (nuts, lentils, chickpeas, kidney beans etc)
Myelomeningocele can be seen after the child is born. A neurologic exam may show that the child has loss of nerve-related functions below the defect. For example, watching how the infant responds to pinpricks at various locations may reveal where the baby can feel the sensations.
Tests done on the baby after birth may include x-rays, ultrasound, CT, or MRI of the spinal area.
In cases where a severe defect is detected early in the pregnancy, abortion may be considered.
After your baby is born, surgery to repair the defect is most often recommended within the first few days of life.
Before surgery, the infant must be handled carefully to reduce damage to the exposed spinal cord. This may include special care and positioning, protective devices, and changes in the methods of handling, feeding, and bathing.
Most children will require lifelong treatment for problems that result from damage to the spinal cord and spinal nerves.
A myelomeningocele can most often be surgically corrected, but the affected nerves may still not function normally. (The higher the location of the defect on the baby's back, the more nerves will be affected.)
With early treatment, length of life is not severely affected. Kidney problems due to poor drainage of urine are the most common cause of death.
Because of the risk of hydrocephalus and meningitis, more of these children will have learning problems and seizure disorders.
New problems within the spinal cord can develop later in life, especially after the child begins growing rapidly during puberty. This can lead to more loss of function as well as orthopedic problems such as scoliosis, foot or ankle deformities, dislocated hips, and joint tightness or contractures.
Complications of spina bifida may include:--
Traumatic birth and difficult delivery of the baby
Frequent urinary tract infections
Fluid buildup on the brain (hydrocephalus)
Loss of bowel or bladder control
Low blood oxygen level in the baby
Brain infection (meningitis)
Permanent weakness or paralysis of legs
Call your doctor if:
A sac or open area is visible on the spine of a newborn infant
The child is late in walking or crawling
Symptoms of hydrocephalus develop, including bulging soft spot, irritability, extreme sleepiness, and feeding difficulties
Symptoms of meningitis develop, including fever, stiff neck, irritability, and a high-pitched cry
Again, Spina bifida belongs to a group of disorders known as neural tube defects (NTDs). These all involve problems in the development and closure of the neural tube, a structure in the human fetus that begins forming very early in a pregnancy.
The neural tube eventually becomes the spinal column. When the neural tube does not close properly, it can lead to spina bifida, a disruption in the spinal column. Spina bifida occurs to varying degrees of severity, and in various forms..
Spina bifida is also known by the name spinal dysraphism.
It generally occurs in two major types. One types is spina bifida cystica or spina bifida aperta, which involves a sac filled with spinal contents along the spine. The other type is spina bifida occulta, in which the spinal cord stays inside the spinal canal and there is no sac.
Spina bifida ranges from having no or mild effects, to having severe effects and a significant impact upon a person's life. Physical symptoms can include weakness of limbs, paralysis, lack of bowel or bladder control, learning problems, hydrocephalus , seizures , central apnea, club-feet, impaired vision, and latex sensitivity.
Spina bifida is one of the most common birth defects worldwide. This is a defect in the closure of the vertebral column that may or may not involve the spinal cord or meninges (covering layers of central nervous system) or both being out-pouched. SB is called a neural tube defect (NTD).
There are three types of SB,--
Spina bifida occulta (surface area of some of the vertebrae is not completely closed).
Spina bifida cystica with meningocele (meninges are pushed into the gaps of vertebrae).
Treatment by stem cells is a new way of treating the neural tube diseases. Damaged cells of the spinal cord in spina bifida do not repair themselves. But, the stem cells have the ability to divide and to differentiate into cells of the spinal cord.
When stem cells are introduced in a damaged area, they can repair cells of that area. So, complications due to damaged cells can be minimized.
Stem cells can be extracted from pre-natal as well as post-natal patients. In pre-natal patients, embryonic cells, amniotic mesenchymal stem cells and umbilical cord blood are collected for their stem cells
When a developing baby cannot move their limbs well in utero, this sometimes leads to feet and legs that turn inward, or clubfoot. As a result, some children with spina bifida are born with clubfoot. You must have often wondered why this happens, right?
Myelomeningoceles often cause spinal fluid to not flow properly through the system, and hydrocephalus may be a result. Head ultrasound scans may show hydrocephalus in about 90% of newborns with spina bifida.
Hydrocephalus can eventually cause increased pressure to develop in the brain. This may ultimately lead to one's brain not being able to grow properly, and cause learning problems. Seizures may also be present. Children with hydrocephalus have lower IQs than their siblings without the condition.
Again, Hydrocephalus is the accumulation of excessive amounts of CSF in the brain. It can affect as many as 90% of children with myelomeningocele. It can raise intracranial pressure (ICP) that may prove fatal if not treated on time.
In about 5% of spina bifida cases, there is no spinal tissue in the cyst wall; these are called meningoceles. Hydrocephalus is not usually present in this type of spina bifida, and a neurological examination may even be perfectly normal.
There is no known cure for spina bifida.
Treatment primarily focuses on dealing with symptoms as they arise, since they vary so greatly from person to person.
Surgery to correct the spinal problem in spina bifida cystica is often done. This involves carefully tucking the spinal contents back into the spinal column, and closing the covering back up.
Generally, muscular imbalance is present in patients with myelomeningocele, which results in joint contractures and developmental problems, such as hip dislocation and spinal deformities.
Children with myelomeningocele tend to demonstrate generalized deficits in visual memory and auditory/verbal memory.
Approximately 25-35% or more of children with myelomeningocele are born with hydrocephalus, and an additional 60-70% of patients with myelomeningocele develop hydrocephalus after closure of the myelomeningocele lesion.
Hydrocephalus can cause expansion of the ventricles and loss of cerebral cortex and is associated with an increased risk of cognitive impairment.
Seizures occur in 10-30% of affected children and adolescents.
Renal failure is still the leading cause of death in patients with myelomeningocele after the first year of life.
In general, infants with spina bifida cystica present with the following:
Ocular motor incoordination
Older children may present with the following:-
Cognitive or behavioral changes
Changes in bowel or bladder function
Lower cranial nerve dysfunction
Worsening spinal or lower extremity orthopedic deformities
Children with myelomeningocele are often short in stature.
Meningocele and myelomeningocele must be differentiated. Meningocele is the herniated protrusion of only the meninges through a defect in the cranium or vertebral column. This lesion does not contain neural tissue in the sac.
Spina bifida occulta is characterized by simple lack of fusion of vertebral spinous processes. The spinal cord itself is normal.
Children with spina bifida often have impairment in fine motor skills and in conducting activities of daily living (ADL).
Children with myelomeningocele often experience restricted play and recreational opportunities because of limited mobility and physical limitations. This inactivity decreases the potential for normal development in all spheres and can exert a negative impact on self-esteem.
Spina Bifida Occulta is considered to be a mild form of the defect. The spinal cord and surrounding structures are still inside the baby, but the bones of the lower back fail to form normally. This leaves a hairy patch or dimple over the affected area of the spine.
A meningocele is a CSF-filled extension of his spinal canal, without any spinal cord or spinal nerves in it
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KYA AAPKE GAAND KE OOPAR BAAL HAI ?
KYA AAPKE TOOTHPASTE MEIN NAMAK HAI?
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Optic atrophy and squinting may occur in people who have spina bifida, and a result of these may be poorer vision.
TO BE CONTINUED--
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