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Occult spinal dysraphism in the infant
V M Kriss1, T C Kriss, N S Desai
1Department of Diagnostic Radiology, University of Kentucky Medical Center, Lexington 40536-0084, USA.
Insights
Early detection of occult spinal dysraphism in infants is crucial. Spinal sonography for newborns with lumbosacral skin abnormalities can prevent irreversible neurologic damage.
Area of Science:
- Pediatric Neurology
- Medical Imaging
- Neurosurgery
Background:
- Occult spinal dysraphism can lead to progressive neurologic dysfunction.
- Early detection and treatment are key to preventing irreversible sequelae.
- Diagnosis is challenging as symptoms often appear late, during ambulation.
Purpose of the Study:
- To highlight the importance of early detection of occult spinal dysraphism.
- To identify high-risk infants who may benefit from screening.
- To emphasize the utility of spinal sonography as a noninvasive screening tool.
Main Methods:
- Review of clinical presentation and diagnostic challenges.
- Identification of cutaneous stigmata indicative of underlying spinal anomalies.
- Recommendation for spinal sonography in asymptomatic neonates with specific skin findings.
Main Results:
- Cutaneous stigmata over the lumbosacral spine (hemangiomas, hairy patches, dimples, masses) can indicate occult spinal dysraphism in neonates.
- Neurologic symptoms may not be apparent until later childhood.
- Spinal sonography is an effective, noninvasive screening method for high-risk infants.
Conclusions:
- Early clinical recognition and diagnosis are vital for preventing neurologic deterioration.
- Spinal sonography should be considered for asymptomatic neonates presenting with midline, lumbosacral cutaneous stigmata.
- Timely neurosurgical intervention can mitigate serious, irreversible outcomes.
Abstract:
The progressive neurologic dysfunction caused by occult spinal dysraphism can be prevented with early clinical recognition, radiographic diagnosis, and neurosurgical treatment. However, detection of occult spinal dysraphism in the infant is difficult because neurologic symptoms often are not apparent until the child becomes ambulatory. Occult spinal dysraphism, however, can be suspected in the asymptomatic neonate when cutaneous stigmata, such as hemangiomas, hairy patches, deep and/or eccentric dimples, or subcutaneous masses are seen over the lumbosacral spine. Because of the serious, often irreversible, sequelae of a delayed diagnosis, spinal sonography of high-risk infants with midline, lumbosacral, cutaneous stigmata should be considered as an effective, noninvasive screening method.