A rare case of spina occulta

Introduction

Diastematomyelia, also termed split cord malformation (SCM), is a rare form of occult spinal dysraphism characterized by the cleft in spinal cord. Prenatal diagnosis is possible bu ultrasonography (US), and fetal MRI can be used to diagnose the type of diastelatommyelia precisely. This anomaly can be isolated or associated with other dysraphism, segmental anomalies of the vertebral bodies, or visceral malformations. In isolated diastematomyelia, the skin is intact ant the prognosis excellent.

Objectives

We present a case of SCM with low attached spinal cord and a lipoma of the conus diagnosed in our institution as well as a review of the literature in order to determine the prognodis of isolated case of this unusual condition.

Case(s)

Routine US in a 22 weeks pregnant woman revealed a spinal abnormality of the fetus. There was a intra spinal hyper echogenicity opposite the third lumbar vertebra, with a mature posterior vertebral integrated and intact skin surface. It was difficult to see the spinal cord due to acoustic shadowing. MRI was performed during the 33rd week of gestation and confirmed the presence terminal SCM and low attached spinal cord. After the vaginal delivery at term, the child’s development was normal. The MRI was done after 2 months, it confirmed the prenatal diagnosis: there was no cerebral abnormalities, there was a spinal dysraphism consisting on a law attached spinal cord associated to a lumbar diastematomyelia and a spinal lipoma of the terminal conus. We classified this SCM type 2 with good prognosis.

Conclusion

Prenatal knowledge of spinal cord anomalies is important for prenatal counseling as well assurgical treatment. Since MRI shows these lesions better and with less inter-observer variation than US, in patients with suspected spinal anomalies, either diagnosed on US or based on clinical and laboratory criteria, fetal MRI should be used prior to further management.

Keywords

Spina occulta, diastematomyelia, lipoma of the conus

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	File/Dsecription
	Figure 1 Distematomyelia
	Figure 2 Lipoma of the conus second trimester
	Figure 3 Lipoma third trimester