A young child with recurrent bacterial meningitis should be clinically evaluated for the presence of
Correct Answer: Spina bifida occulta with a dermal sinus tract
Description: Spina bifida is a general term that refers to the abnormal fusion of the veebral arches of the lowest veebrae, usually in the sacrolumbar region. There are several disorders in this group of developmental abnormalities that have varying degrees of severity. Spina bifida occult is the mildest form and is characterized by failure of veebral fusion only. The spinal cord and meninges are normal. In spina bifida occult the defect in the closure of the neural tube is covered by skin and dermis, with only a pinpoint sinus or hair-covered depression marking the site. Bacterial meningitis, or meningomyelitis, is the major potential risk in these patients. The remaining types of spina bifida are classified as spina bifida cystic. Spina bifida with a meningocele is characterized by protrusion through the veebral defect of a meningeal sac filled with cerebrospinal fluid (CSF). Because the cord is in its normal location, there are minimal neurologic deficits. Next in severity is spina bifida with a myelomeningocele, which is characterized by herniation of the cord and a meningeal sac through the veebral defect. This abnormality is often associated with severe neurologic defects in the lower extremities, bladder, and rectum. The most severe form of spina bifida, spina bifida apea or myeloschisis, results from complete failure of fusion of the caudal end of the neural plate, which lies open on the skin surface. This abnormality also results in severe neurologic defects in the legs, bladder, and rectum. Reference: GHAI Essential pediatrics, 8th edition
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Pediatrics
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