2. CASE
 The
pediatrician is called to the delivery
room because an infant is born with a
defect in the lumbosacral area.

3. This is what the baby presented

4. MYELOMENINGOCELE
Cases from Hospital Manuel de Jesus Rivera “La Mascota”
National Children’s Hospital Managua, Nicaragua
IMELDA MEDINA, MD

5. MYELOMENINGOCELE
 Neural
 The
tube defect
most severe form of dysraphism
involving the vertebral column.

6. MYELOMENINGOCELE
Etiology
 Unknown
 It
is thought that agents such as drugs,
radiation, malnutrition (Specially folic acid
deficiency during prenatal period), and
genetics have a role in adversely affecting
normal CNS development.

7. MYELOMENINGOCELE
Clinical Presentation
 Defect
in the Lumbosacral region
 Bowel and bladder incontinence
 Physical Exam:
 Flaccid
paralysis of lower extremities
 Absent deep tendon reflexes, lack of response to
touch or pain
 Postural abnormalities including clubfoot or subluxed
hips may be present.
 80% develop hydrocephalus associated with Type II
Chiari defect.

8. MYELOMENINGOCELE
Prenatal Diagnostic Studies
 Prenatal
screening of AFP (AlphaFetoprotein acetylcholinesterase) at 16-18
weeks.
 AFP
is excreted from the fetus and leaks into the amniotic
fluid when there is failure of the neural tube to close.

9. MYELOMENINGOCELE
Treatment
 Prenatal
Folic acid and vitamins, adequate
nutrition and Ob/Gyn care
 Multidisciplinary
care needed (Pediatrics,
Neurology, Urology, Neurosurgery,
Occupational/Physical therapists, etc).
 Surgical
repair of Lumbosacral defect and
ventriculo-peritoneal shunt for those who
develop hydrocephalus.

10. MYELOMENINGOCELE
 Complications
 Potential
Herniation of the medulla and cerebellar
tonsils through the foramen magnum secondary to
Chiari II malformation

Monitor for clinical presentation: Feeding problems, drooling,
choking, DEATH if left untreated.
 Infections:
Meningitis, UTI’s
Treat with IV antibiotics
 Prevent UTI’s with frequent catheterizations


11. MYELOMENINGOCELE

12. MYELOMENINGOCELE
Club Foot

13. MYELOMENINGOCELE
Hydrocephalus

14. MYELOMENINGOCELE
Ventriculomegaly

15. MYELOMENINGOCELE
Ventriculomegaly

16. Ventricular Puncture
Hospital Manuel de Jesus Rivera “La Mascota”
Marina Morales, MD; Miguel Angel Guevara, MD

17. Ventricular Puncture
Hospital Manuel de Jesus Rivera “La Mascota”
Marina Morales, MD; Miguel Angel Guevara, MD

18. BIBLIOGRAPHY

9.Nelson’s Textbook of Pediatrics. Berhrman RE,
Kliegman R, Jensen Hal, W.B. Saunders Co,
Philadelphia, 2000, 16th ed. P 1804-1806.

Hospital Manuel de Jesus Rivera “La Mascota.” Neonatal
Intensive Care Unit Department, Isolation Unit. Photos
taken by Imelda Medina, MD with informed consent
from parents and faculty at the Institution. March-May
2005

19. THE END