Spina bifida Neurological disorder

this content will be useful for nursing students

1. SPINA BIFIDA

2. SPINA BIFIDA DEFINITION: Spina bifida is a malformation of spine, in which posterior portion of lamina of vertebra fail to close with or without defective development of spinal cord. INCIDENCE: 1 or 2 per 1000 live births

3. ETIOLOGY: Genetic Maternal age Environmental Diet

4. CLASSIFICATION: SPINA BIFIDA SPINA BIFIDA CYSTICA MENINGOCELE MYELOMENINGOCELE SPINA BIFIDA OCCULTA

5. SPINA BIFIDA OCCULTA: It is a defect which result from failure of formation of bony arch around the spinal cord, but spinal cord and meninges are normal. It is not visible externally and is asymptomatic.

6. SPINA BIFIDA CYSTICA: Spina bifida cystica is a defect in the closure of posterior vertebral arch with protrusion of spinal cord and meninges through the defect. Meningocele : It is a sac like herniation through the bony malformation, containing meninges and cerebrospinal fluid. Myelomenigocele : It is a sac like protrusion of spinal cord, CSF and meninges through spinal cleft. It is mostly found in lumbar or lumbosacral region.

7. PATHOPHYSIOLOGY: It occurs due to defect in the orderly closure of vertebral column and formation of spinal cord during 4 th or 6 th weeks of gestation. During the 3 rd week of gestation, a depression forms in the dorsal of the ectoderm in embryo. This depression becomes deeper and its margins close dorsally to create neural tube and that becomes spinal cord and brain. Exact mechanism by which neural tube defect occurs is not certain.

8. CLINICAL FEATURES: Spina bifida occulta : Spina bifida occulta are asymptomatic, the only features seen are: Dimple in the skin or growth of hair over malformed vertebra. As the child grows, he may develop foot weakness or disturbances of bladder and bowel sphincter.

9. B. Spina bifida cystica : Meningocele : External cystic defect Weakness of leg or lack of sphincter control. 2. Myelomeningocele : Herniated mass in lumbosacral region Hydrocephalus Loss of motor control Congenital skeletal anomalies

10. DIAGNOSTIC EVALUATION: Ultrasound Fetal MRI Amniocentesis Sac may be seen on the back of the baby CT scan and MRI of spinal cord and brain

11. MANAGEMENT: It depends on the nature and extent of defect. Usually no intervention is required for spina bifida occulta . For spina bifida cystica surgery is required laminectomy and closure of the defect is done within 24- 48 hours of birth.

12. NURSING MANAGEMENT: The main aim of pre and post- operative nursing care are: Prevention of infection Preventing injury to the sac Prevention of skin breakdown Preventing urinary tract infection Preventing leg and hip deformities Provision of adequate nutrition

13. PROGNOSIS: Myelomeningocele can usually be surgically corrected. With treatment, length of life is not affected, but quality of life is improved. COMPLICATION: Frequent urinary tract infection Hydrocephalus Loss of bladder and bowel control Meningitis Permanent weakness or paralysis of legs

14. PREVENTION: Genetic counseling of at risk couple may be recommended. If severe defect is detected early in pregnancy, therapeutic abortion may be considered. Folic acid supplements.

15. Thank you…!