History

Fact Explanation
Past history/ Family history of a baby with any type of neural tube defect [1] Recurrence rate of neural tube defect is 1:50 (2%)
Local skin change over the back of the baby along the vertebral column. [2] Closed neural tube defects are commonly present with an abnormal manifestation over the spine such as fluid filled cystic lesion, sacral dimple, sacral pits, skin tag, cleft in gluteal region and with some cutaneous lesions like patch of hypopigmentation/ hyperpigmentation, capillary telangiectasia/hemangioma hairy patch (hypertrichosis).
Abnormal curvature of the vertebral column Scoliosis can be a one of presentation in neural tube defects. [3]
Limb weakness [4] / delayed walking/ abnormal walking pattern of the baby This is one of neurological manifestation, due to the lower limb weakness child may delay in starting walking or the gait may be abnormal.
Bladder dysfunction (urinary incontinence/ urinary retention) [4] This is another neurological manifestation. Neurogenic bladder and neurogenic detrusor overactivity may lead to this bladder dysfunction in this patients. [5]
Bowel dysfunction (fecal incontinence/ constipation) [6] This is also due to the neurological involvement.
Low back pain [12] this is a common presentation in older children. this can manifest without any neurological involvement.
Sudden onset pain, limb weakness, Sensory loss, bladder dysfunction after sudden trauma Due to sudden impact over malformed vertebral column, spinal cord can be damaged [14]. tethering of the cord commonly present as this [7].
Gradual onset limb weakness, sensory loss, bladder dysfunction. [9] Patients with congenital dermal sinus with an intraspinal dermoid cyst /neurenteric cyst will present with above symptoms due to gradual compression of the spinal cord by increasing the size of the cyst. [8]
Photo phobia, headache, difficulty in moving the neck Patients with neural tube defects may present with features of meningitis [13]. this meningitis can be a bacterial meningitis or aseptic meningitis. Recurrent attacks of aseptic meningitis [10] [11] can occur due to leaking of the content of a dermoid cyst into the subarachnoid space.
Leg abnormalities [4] Leg deformities like thin calf, higher arch, small foot on the same side, and hammering or clawing of the toes may lead to asymmetry of the legs and/or feet. This is a common presentation
References
  1. SEBOLD CD, MELVIN EC, SIEGEL D, MEHLTRETTER L, ENTERLINE DS, NYE JS, KESSLER J, BASSUK A, SPEER MC, GEORGE TM, NTD COLLABORATIVE GROUP. Recurrence risks for neural tube defects in siblings of patients with lipomyelomeningocele. Genet Med [online] 2005 Jan, 7(1):64-7 [viewed 09 July 2014] Available from: doi:10.109701.GIM.0000151158.09278.2B
  2. GIBSON PJ, BRITTON J, HALL DM, HILL CR. Lumbosacral skin markers and identification of occult spinal dysraphism in neonates. Acta Paediatr [online] 1995 Feb, 84(2):208-9 [viewed 09 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/7756811
  3. ALLAM AM, SCHWABE AL. Neuromuscular scoliosis. PM R [online] 2013 Nov, 5(11):957-63 [viewed 09 July 2014] Available from: doi:10.1016/j.pmrj.2013.05.015
  4. TSENG JH, KUO MF, KWANG TU Y, TSENG MY. Outcome of untethering for symptomatic spina bifida occulta with lumbosacral spinal cord tethering in 31 patients: analysis of preoperative prognostic factors. Spine J [online] 2008 Jul-Aug, 8(4):630-8 [viewed 10 July 2014] Available from: doi:10.1016/j.spinee.2005.11.005
  5. CARDARELLI WJ. Managed care aspects of managing neurogenic bladder/neurogenic detrusor overactivity. Am J Manag Care [online] 2013 Jul, 19(10 Suppl):s205-8 [viewed 09 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24495242
  6. COGGRAVE M, NORTON C, CODY JD. Management of faecal incontinence and constipation in adults with central neurological diseases. Cochrane Database Syst Rev [online] 2014 Jan 13:CD002115 [viewed 09 July 2014] Available from: doi:10.1002/14651858.CD002115.pub5
  7. GUZMAN JZ, BAIRD EO, FIELDS AC, MCANANY SJ, QURESHI SA, HECHT AC, CHO SK. C5 nerve root palsy following decompression of the cervical spine: a systematic evaluation of the literature. Bone Joint J [online] 2014 Jul, 96-B(7):950-5 [viewed 09 July 2014] Available from: doi:10.1302/0301-620X.96B7.33665
  8. MISHRA SS, PANIGRAHI S. Thoracic congenital dermal sinus associated with intramedullary spinal dermoid cyst J Pediatr Neurosci [online] 2014, 9(1):30-32 [viewed 09 July 2014] Available from: doi:10.4103/1817-1745.131478
  9. MAVANI SB, NADKARNI TD. Tethered cord due to caudal lipomeningocele associated with a lumbar dural arteriovenous fistula. J Neurosurg Spine [online] 2014 Jun 27:1-5 [viewed 09 July 2014] Available from: doi:10.3171/2014.5.SPINE13670
  10. VADIVELU S, DESAI SK, ILLNER A, LUERSSEN TG, JEA A. Infected lumbar dermoid cyst mimicking intramedullary spinal cord tumor: Observations and outcomes J Pediatr Neurosci [online] 2014, 9(1):21-26 [viewed 09 July 2014] Available from: doi:10.4103/1817-1745.131475
  11. GAO B, YANG J, ZHUANG S, DENG Y, YANG W, YU Y, WANG Y, LUO L, DAI K. Mollaret meningitis associated with an intraspinal epidermoid cyst. Pediatrics [online] 2007 Jul, 120(1):e220-4 [viewed 09 July 2014] Available from: doi:10.1542/peds.2006-2053
  12. LOHANI S, RODRIGUEZ DP, LIDOV HG, SCOTT RM, PROCTOR MR. Intrasacral meningocele in the pediatric population. J Neurosurg Pediatr [online] 2013 Jun, 11(6):615-22 [viewed 10 July 2014] Available from: doi:10.3171/2013.3.PEDS12519
  13. TABAEE A, ANAND VK, CAPPABIANCA P, STAMM A, ESPOSITO F, SCHWARTZ TH. Endoscopic management of spontaneous meningoencephalocele of the lateral sphenoid sinus. J Neurosurg [online] 2010 May, 112(5):1070-7 [viewed 10 July 2014] Available from: doi:10.3171/2009.7.JNS0842
  14. GUGGENBERGER R, ANDREISEK G, SCHEFFEL H, WILDERMUTH S, LESCHKA S, STOLZMANN P. Absent cervical spine pedicle and associated congenital spinal abnormalities - a diagnostic trap in a setting of acute trauma: case report. BMC Med Imaging [online] 2010 Nov 9:25 [viewed 10 July 2014] Available from: doi:10.1186/1471-2342-10-25

Examination

Fact Explanation
Stillbirth/ death with in few hours of delivery [1] In anencephaly majority of babies are either still born or they die with few hours of delivery, but very rarely a baby may live up to few days
Abnormal face and neck [2] In anencephaly, cranial vault and covering skin is absent either partially or totally. Here usually baby is not having a brain or brain is limited to a small mass.
Local skin change over the vertebral column such as fluid filled cystic lesion, sacral dimple, sacral pits, skin tag, gluteal cleft and cutaneous lesions like patch of hypopigmentation/ hyperpigmentation, capillary telangiectasia/hemangioma hairy patch (hypertrichosis). Closed neural tubes can give local skin manifestations [3]
head circumference Open neural tube defects are commonly affect the entire central nervous system and this can lead to hydrocephalus[4] this manifest as increasing head circumference.
Complete sensory and motor examination (observation- muscle bulk, spontaneous active movements, movements in response to stimulation/ palpation-muscle tone) complete examination will help to identify the motor weakness [5] and sensory impairments. Weakness and sensory loss can be depend on the level of the lesion and the type of the neural tube defect.
Evidence of bladder bowel dysfunction ( fecal/ urine smell- bowel/bladder incontinence, palpable bladder- urinary retention) [6] [7] [8] These are neurological manifestations.Neurogenic bladder and neurogenic detrusor overactivity may lead to urinary retention and urinary incontinence. Bowel dysfunction also can present as either fecal incontinence or constipation.
Examination of the spine for deformities- Kyphosis, scoliosis [9] spinal deformities are associated with neural tube defects.
References
  1. MACHADO IN, MARTINEZ SD, BARINI R. Anencephaly: do the pregnancy and maternal characteristics impact the pregnancy outcome? ISRN Obstet Gynecol [online] 2012:127490 [viewed 09 July 2014] Available from: doi:10.5402/2012/127490
  2. FONG KS, ADACHI DA, CHANG SB, LOZANOFF S. Midline craniofacial malformations with a lipomatous cephalocele are associated with insufficient closure of the neural tube in the tuft mouse. Birth Defects Res A Clin Mol Teratol [online] 2014 Jun 13 [viewed 09 July 2014] Available from: doi:10.1002/bdra.23264
  3. GIBSON PJ, BRITTON J, HALL DM, HILL CR. Lumbosacral skin markers and identification of occult spinal dysraphism in neonates. Acta Paediatr [online] 1995 Feb, 84(2):208-9 [viewed 09 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/7756811
  4. ADZICK NS. Fetal myelomeningocele: natural history, pathophysiology, and in-utero intervention. Semin Fetal Neonatal Med [online] 2010 Feb, 15(1):9-14 [viewed 09 July 2014] Available from: doi:10.1016/j.siny.2009.05.002
  5. TSENG JH, KUO MF, KWANG TU Y, TSENG MY. Outcome of untethering for symptomatic spina bifida occulta with lumbosacral spinal cord tethering in 31 patients: analysis of preoperative prognostic factors. Spine J [online] 2008 Jul-Aug, 8(4):630-8 [viewed 10 July 2014] Available from: doi:10.1016/j.spinee.2005.11.005
  6. TSENG JH, KUO MF, KWANG TU Y, TSENG MY. Outcome of untethering for symptomatic spina bifida occulta with lumbosacral spinal cord tethering in 31 patients: analysis of preoperative prognostic factors. Spine J [online] 2008 Jul-Aug, 8(4):630-8 [viewed 10 July 2014] Available from: doi:10.1016/j.spinee.2005.11.005
  7. CARDARELLI WJ. Managed care aspects of managing neurogenic bladder/neurogenic detrusor overactivity. Am J Manag Care [online] 2013 Jul, 19(10 Suppl):s205-8 [viewed 09 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24495242
  8. COGGRAVE M, NORTON C, CODY JD. Management of faecal incontinence and constipation in adults with central neurological diseases. Cochrane Database Syst Rev [online] 2014 Jan 13:CD002115 [viewed 09 July 2014] Available from: doi:10.1002/14651858.CD002115.pub5
  9. ALLAM AM, SCHWABE AL. Neuromuscular scoliosis. PM R [online] 2013 Nov, 5(11):957-63 [viewed 09 July 2014] Available from: doi:10.1016/j.pmrj.2013.05.015

Differential Diagnoses

Fact Explanation
Meningitis Meningitis mainly present with photophobia, neck stiffness and headache. [1] but neonates and small children may present with various symptoms like- poor feeding, unresponsiveness
Spinal Cord Hemorrhage Patients may present with sudden onset severe back pain and various neurological symptoms [2] such as hemiparesis/ paraparesis/ quadriparesis, sensory loss below lesion and loss of sphincter control
Spinal cord infarction Patients may present with various neurological symptoms according to the level and area of infarction [3].
Spinal epidural abscess With is patients may present with fever/chills(67%) , localized spinal pain (89%), radicular pain(57%) [4] and neurological symptoms like paresthesias, muscular weakness, sensory loss, and sphincter dysfunction.
Syringomyelia syringohydromyelia is a condition with cystic dilatation of the lower third of the spinal cord.Common presentation ot this is pain, motor and sensory deficits of the lower extremities, scoliosis, and bowel and bladder dysfunction. [5]
References
  1. FAYYAZ J, REHMAN A, HAMID A, KHURSHEED M, ZIA N, FEROZE A. Age related clinical manifestation of acute bacterial meningitis in children presenting to emergency department of a tertiary care hospital. J Pak Med Assoc [online] 2014 Mar, 64(3):296-9 [viewed 10 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24864603
  2. MATSUMURA A, NAMIKAWA T, HASHIMOTO R, OKAMOTO T, YANAGIDA I, HOSHI M, NOGUCHI K, TAKAMI M. Clinical management for spontaneous spinal epidural hematoma: diagnosis and treatment. Spine J [online] 2008 May-Jun, 8(3):534-7 [viewed 10 July 2014] Available from: doi:10.1016/j.spinee.2007.01.009
  3. WEIDAUER S, NICHTWEISS M, LANFERMANN H, ZANELLA FE. Spinal cord infarction: MR imaging and clinical features in 16 cases. Neuroradiology [online] 2002 Oct, 44(10):851-7 [viewed 10 July 2014] Available from: doi:10.1007/s00234-002-0828-5
  4. TANG HJ, LIN HJ, LIU YC, LI CM. Spinal epidural abscess--experience with 46 patients and evaluation of prognostic factors. J Infect [online] 2002 Aug, 45(2):76-81 [viewed 10 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/12217707
  5. ISKANDAR BJ, OAKES WJ, MCLAUGHLIN C, OSUMI AK, TIEN RD. Terminal syringohydromyelia and occult spinal dysraphism. J Neurosurg [online] 1994 Oct, 81(4):513-9 [viewed 10 July 2014] Available from: doi:10.3171/jns.1994.81.4.0513

Investigations - for Diagnosis

Fact Explanation
Ultrasonography [1] This is the gold standard method [1]. Earliest period is to be diagnosed between 11-14 weeks as skull ossification is not complete until 11 weeks. A repeat scan between 18-20 weeks is usually offered to confirm this diagnosis. Anencephaly, scalloping of the frontal bones-lemon sign and anterior curvature of the cerebellar hemispheres-banana sign are the features suggestive of neural tube defects on ultrasound scan. [5] Postnatally role is limited but useful in screening for hydrocephalus.
Magnetic Resonance Imaging (MRI) [2] This is helpful in visualizing both intracranial and intraspinal abnormalities. MRI useful for Antenatal diagnosis as well [3].
Computer thermography (CT) scan CT scan helpful in visualizing the skeletal defects/abnormalities [4] and intracranial abnormalities (Hydrocephalus).
References
  1. JOó JG, BEKE A, PAPP C, TóTH-PáL E, CSABA A, SZIGETI Z, PAPP Z. Neural tube defects in the sample of genetic counselling. Prenat Diagn [online] 2007 Oct, 27(10):912-21 [viewed 08 July 2014] Available from: doi:10.1002/pd.1801
  2. KAWAMURA T, MORIOKA T, NISHIO S, MIHARA F, FUKUI M. Cerebral abnormalities in lumbosacral neural tube closure defect: MR imaging evaluation. Childs Nerv Syst [online] 2001 Jun, 17(7):405-10 [viewed 10 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/11465794
  3. WILLIAMS F, GRIFFITHS PD. Spinal neural tube defects on in utero MRI. Clin Radiol [online] 2013 Dec, 68(12):e715-22 [viewed 10 July 2014] Available from: doi:10.1016/j.crad.2013.07.019
  4. GUGGENBERGER R, ANDREISEK G, SCHEFFEL H, WILDERMUTH S, LESCHKA S, STOLZMANN P. Absent cervical spine pedicle and associated congenital spinal abnormalities - a diagnostic trap in a setting of acute trauma: case report. BMC Med Imaging [online] 2010 Nov 9:25 [viewed 10 July 2014] Available from: doi:10.1186/1471-2342-10-25
  5. HAMILTON RA, DORNAN JC. Neural tube defects--prenatal diagnosis and management. Ulster Med J [online] 1992 Oct, 61(2):127-133 [viewed 11 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2448947

Investigations - Fitness for Management

Fact Explanation
Urodynamic studies [1] This will help to analyze bladder functioning.
Renal function tests [1][3] Important in evaluating the kidney functions as neurogenic bladder and neurogenic detrusor overactivity may lead to bladder dysfunction in these patients. [2]
References
  1. PETERS KM, GILMER H, FEBER K, GIRDLER BJ, NANTAU W, TROCK G, KILLINGER KA, BOURA JA. US Pilot Study of Lumbar to Sacral Nerve Rerouting to Restore Voiding and Bowel Function in Spina Bifida: 3-Year Experience. Adv Urol [online] 2014:863209 [viewed 10 July 2014] Available from: doi:10.1155/2014/863209
  2. CARDARELLI WJ. Managed care aspects of managing neurogenic bladder/neurogenic detrusor overactivity. Am J Manag Care [online] 2013 Jul, 19(10 Suppl):s205-8 [viewed 09 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24495242
  3. DIK P, KLIJN AJ, VAN GOOL JD, DE JONG-DE VOS VAN STEENWIJK CC, DE JONG TP. Early start to therapy preserves kidney function in spina bifida patients. Eur Urol [online] 2006 May, 49(5):908-13 [viewed 11 July 2014] Available from: doi:10.1016/j.eururo.2005.12.056

Investigations - Followup

Fact Explanation
Ultrasonography [1] Postnatally role is limited but useful in screening for hydrocephalus. As there is a recurrence of neural tube defects anomaly scan looking specifically for this condition is help full antenatally in mothers with either positive past/family history of neural tube defects.
Genetic screening Several genetic factors are proven to be associated with neural tube defect[2][3]. Some chromosomal abnormalities such as trisomy 13, 18, 21 associated with this condition.
Urodynamic studies [4] As neural tube defects can cause bladder dysfunction, Urodynamic studies will helpful in follow up to assess the present condition.
Renal function tests [4][6] Bladder dysfunction can affect renal function of the patient.
Urine full report [5] Due to bladder dysfunction and intermittent catheterization[7], patients are at risk of getting frequent urinary tract infections.
References
  1. JOó JG, BEKE A, PAPP C, TóTH-PáL E, CSABA A, SZIGETI Z, PAPP Z. Neural tube defects in the sample of genetic counselling. Prenat Diagn [online] 2007 Oct, 27(10):912-21 [viewed 08 July 2014] Available from: doi:10.1002/pd.1801
  2. DE MARCO P, MERELLO E, CAMA A, KIBAR Z, CAPRA V. Human neural tube defects: genetic causes and prevention. Biofactors [online] 2011 Jul-Aug, 37(4):261-8 [viewed 11 July 2014] Available from: doi:10.1002/biof.170
  3. KIBAR Z, CAPRA V, GROS P. Toward understanding the genetic basis of neural tube defects. Clin Genet [online] 2007 Apr, 71(4):295-310 [viewed 11 July 2014] Available from: doi:10.1111/j.1399-0004.2007.00793.x
  4. PETERS KM, GILMER H, FEBER K, GIRDLER BJ, NANTAU W, TROCK G, KILLINGER KA, BOURA JA. US Pilot Study of Lumbar to Sacral Nerve Rerouting to Restore Voiding and Bowel Function in Spina Bifida: 3-Year Experience. Adv Urol [online] 2014:863209 [viewed 10 July 2014] Available from: doi:10.1155/2014/863209
  5. MADDEN-FUENTES RJ, MCNAMARA ER, LLOYD JC, WIENER JS, ROUTH JC, SEED PC, ROSS SS. Variation in definitions of urinary tract infections in spina bifida patients: a systematic review. Pediatrics [online] 2013 Jul, 132(1):132-9 [viewed 11 July 2014] Available from: doi:10.1542/peds.2013-0557
  6. DIK P, KLIJN AJ, VAN GOOL JD, DE JONG-DE VOS VAN STEENWIJK CC, DE JONG TP. Early start to therapy preserves kidney function in spina bifida patients. Eur Urol [online] 2006 May, 49(5):908-13 [viewed 11 July 2014] Available from: doi:10.1016/j.eururo.2005.12.056
  7. ZEGERS BS, UITERWAAL CC, VERPOORTEN CC, CHRISTIAENS MM, KIMPEN JJ, DE JONG-DE VOS VAN STEENWIJK CC, VAN GOOL JJ. Home screening for bacteriuria in children with spina bifida and clean intermittent catheterization. BMC Infect Dis [online] 2012 Oct 20:264 [viewed 11 July 2014] Available from: doi:10.1186/1471-2334-12-264

Investigations - Screening/Staging

Fact Explanation
Maternal serum-AFP tests Alpha fetoprotein(AFP) is a fetal protein. When fetus has a open neural tube defect There is more leakage of AFP to the amniotic fluid. It causes increased level of AFP. This test has a limited reliability, but useful and necessary in screening. This usually performed on a pregnant woman's blood around 16-18 weeks of pregnancy. Among neural tube defects anencephaly has the highest sensitivity while encephalocele has the lowest sensitivity for the test. [1]
Genetic testing Several genetic factors are proven to be associated with neural tube defect. [2] In a couple who has a child with neural tube defect, there is a 2-5% increased risk of having a second child with the same condition.
Chorocentesis and amniocentesis As there are chromosomal abnormalities associated with neural tube defects, it is important to exclude those by chorocentesis and amniocentesis in the antenatal period. [3]
References
  1. JOó JG, BEKE A, PAPP C, TóTH-PáL E, CSABA A, SZIGETI Z, PAPP Z. Neural tube defects in the sample of genetic counselling. Prenat Diagn [online] 2007 Oct, 27(10):912-21 [viewed 08 July 2014] Available from: doi:10.1002/pd.1801
  2. DE MARCO P, MERELLO E, CAMA A, KIBAR Z, CAPRA V. Human neural tube defects: genetic causes and prevention. Biofactors [online] 2011 Jul-Aug, 37(4):261-8 [viewed 11 July 2014] Available from: doi:10.1002/biof.170
  3. HAMILTON RA, DORNAN JC. Neural tube defects--prenatal diagnosis and management. Ulster Med J [online] 1992 Oct, 61(2):127-133 [viewed 11 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2448947

Management - General Measures

Fact Explanation
Options after antenatal diagnosis If the conditions are permissible, termination of pregnancy [1] can be considered depend on the opinion of the couple. If they want to continue the pregnancy even in the presence of anencephaly, the vaginal delivery should be planned.
Multidisciplinary management approach A babies with NTD are particularly vulnerable for lot of complications such as it is important to have a multidisciplinary approach in the management involving various specialties [2]. eg:- Neurosurgeon, urologist, orthopedic surgeon, physiotherapists etc.
Surveillance and public health programms Educational programmes are important to prevent preventable NTDs. Food fortification is also important in prevention. [3]
References
  1. HAMILTON RA, DORNAN JC. Neural tube defects--prenatal diagnosis and management. Ulster Med J [online] 1992 Oct, 61(2):127-133 [viewed 11 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2448947
  2. DIK P, KLIJN AJ, VAN GOOL JD, DE JONG-DE VOS VAN STEENWIJK CC, DE JONG TP. Early start to therapy preserves kidney function in spina bifida patients. Eur Urol [online] 2006 May, 49(5):908-13 [viewed 11 July 2014] Available from: doi:10.1016/j.eururo.2005.12.056
  3. JENTINK J., VAN DE VRIE-HOEKSTRA N. W., DE JONG-VAN DEN BERG L. T. W., POSTMA M. J.. Economic evaluation of folic acid food fortification in The Netherlands. The European Journal of Public Health [online] 2008 February, 18(3):270-274 [viewed 11 July 2014] Available from: doi:10.1093/eurpub/ckm129

Management - Specific Treatments

Fact Explanation
Folic acid [1] [2] Folic acid :400 micrograms (from 3 months before pregnancy up to 12 weeks) or 5 mg if there is a positive family history of neural tube defects is indicated. Folic acid is proven to be effective in reducing the new cases and recurrence of spina bifida and anencephaly and also to reduce the chance of other birth defects such as cardiac, orofacial, limb, and renal anomalies. [3]
Neonatal care In a newborn with open neural tube defects, there is a risk of baby become hypothermia, and infections.So the newborn should be covered with sterile, warm, wet dresses. They may require intensive care.
Surgical closure of the defect Surgical closure should be done for open neural tube defects. [6]
Ventriculoperitoneal shunt placement Shunts are inserted for the treatment or prevention of hydrocephalus. Coagulase negative staphylococcus and gram negative bacteria can complicate the shunts. [5]
Intermittent catheterization [4] Due to neurogenic bladder patient will present with urinary retention. Intermittent self catheteriztion is recommend to maintain bladder care.
References
  1. YOUNGBLOOD ME, WILLIAMSON R, BELL KN, JOHNSON Q, KANCHERLA V, OAKLEY GP JR. 2012 Update on global prevention of folic acid-preventable spina bifida and anencephaly. Birth Defects Res A Clin Mol Teratol [online] 2013 Oct, 97(10):658-63 [viewed 09 July 2014] Available from: doi:10.1002/bdra.23166
  2. KONDO A, KAMIHIRA O, OZAWA H. Neural tube defects: prevalence, etiology and prevention. Int J Urol [online] 2009 Jan, 16(1):49-57 [viewed 09 July 2014] Available from: doi:10.1111/j.1442-2042.2008.02163.x
  3. TORIELLO HELGA V. Folic acid and neural tube defects. Genet Med [online] 2005 April, 7(4):283-284 [viewed 11 July 2014] Available from: doi:10.1097/00125817-200504000-00009
  4. NAZARKO L. Intermittent self-catheterisation: past, present and future. Br J Community Nurs [online] 2012 Sep, 17(9):408, 410-12 [viewed 11 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23123484
  5. SARGUNA P, LAKSHMI V. Ventriculoperitoneal shunt infections. Indian J Med Microbiol [online] 2006 Jan, 24(1):52-4 [viewed 11 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/16505557
  6. GUTHKELCH AN. Surgical closure of the back lesion in open neural tube defects. BMJ [online] 1988 Jul 2, 297(6640):67 [viewed 11 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1834147