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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
Widely separated composite split cord malformation
  1. Deepak Kumar Singh1,
  2. Neha Singh2,
  3. Ragini Singh3
  1. 1Department of Neurosurgery, Dr. RMLIMS, Lucknow, Uttar Pradesh, India
  2. 2Department of Radiodiagnosis, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India,
  3. 3Department of Radiodiagnosis & Imaging, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India
  1. Correspondence to Dr Neha Singh, neha.singh.dr{at}gmail.com

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Summary

We are reporting a rare case of 18-month-old child with split cord malformations (SCMs) at two different levels, one in the upper thoracic (T2) and the other in the lumbar (L2) region. Only few case reports of such wide separation of SCM are available in the published literature.

Background

Split cord malformation (SCM) constitutes approximately one-third cases of spinal dysraphism, characterised by longitudinal splitting of spinal cord into two halves with a bony or fibrous spur. Composite types of SCMs are very rare and are characterised by the presence of two different forms of SCM with intervening normal cord in same patient. These malformations are the consequences of two different foci of ectoendodermal adhesions and endomesenchymal tracts, which ultimately lead to development of different SCM types with intervening normal cord.

Case presentation

An 18-month-old male child presented with progressively increasing weakness of right foot since birth. Physical examination revealed pigmented skin in upper thoracic and mid-lumbar region with overlying hypertrichosis (figure 1). Tenderness was noted on direct palpation over these areas. Clubfoot was noted on right side and its power was reduced (grade 3/5). Power was normal in rest of the limbs and sphincter functions were normal. Developmental assessment revealed normal milestones and growth parameters were within normal range.

Figure 1

Pigmented skin in the upper thoracic and the mid-lumbar region.

MRI of thoracic spine revealed low-lying spinal cord tethered with the posterior element of L5 vertebra. Longitudinal split of dural …

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