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    Neuroanatomy: Swelling in Fourth and Fifth Lumbar Vertebra

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    A pediatrician examining an infant found a large swelling in the lower part of the infants back over the fourth and fifth lumbar vertebra. The summit of the swelling had an oval raw area from which a clear fluid was discharging. The legs were hyperextended and feet were held in a position of talipes calcaneus.

    What is the problem?

    Explain all aspects of the defect on the back.

    [I think it may be spina bifida meningocele, since there is not mention of spinal cord in the swelling. however i am not sure and i don't know why the swelling would have a discarge (CSF)... lack of folate and possible the LE issues are residual due to residual paralysis... Can anyone help me??]

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    Solution Preview

    I'm going to go through each of the symptoms one by one, and explain what we can learn from them:

    "a large swelling in the lower part of the infants back over the fourth and fifth lumbar vertebra"

    As you mentioned, this is most likely some form of spina bifida, a defect of the spinal column that is caused by the neural tube failing to close completely during embryonic development. Neural tube defects (NTDs) can run in families, so the cause is at least partly genetic, but there are also environmental causes -- some medicines increase the risk of NTDs, and taking folic acid supplements can decrease the risk.

    The malformed region of the spinal column ...

    Solution Summary

    The solution uses the symptoms mentioned in the problem to determine the most likely diagnosis as well as the level of injury.