Jackofknives
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During a pregnancy, amniocentesis reveals elevated levels of alpha-fetoprotein, and ultrasound imaging indicates the presence of a cyst in the dorsal midline in the lower lumbar region. Corrective postnatal surgery reveals that the cyst contains cerebrospinal tluid but no neural tissue. What is your evaluation of the cyst?
(A) It is seen in infants with spina bifida occulta.
(B) It was a meningomyelocele.
(C) It was an Arnold Chiari formation.
(D) It results from the rostral neuropore failing to close.
(E) It was a cystocele.
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| ManuNastai
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it's a meningocele... D
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| Jackofknives
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Actually none of them is correct. MN, the idea is good, but option D, "rostral neuropore failing to close" will result in anencephaly, so that's not it.
PS this Q is from Kaplan lecture book, another flawed question.
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| hedieh
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answer D is correct, Jackofknifes, anencephacephaly is failure of anterior or cephalade noropore to close. Failure of rostral or caudal noropore to close: meninigocele, meningomyelocele, spina bifida.
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| Jackofknives
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"ultrasound imaging indicates the presence of a cyst in the dorsal midline in the lower lumbar region."
Option (D) It results from the rostral neuropore failing to close.
Rostral neuropore failing to close will result in anencephacephly which consists of many forms, anecephaly, meingeocele, meningeoencephalocele, meningeohydroencephalocele, but never something related to spina bifida, and never ever something related to the lower lumber region. So my opinion is that D is wrong as well.
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| virgola82
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Shouldn't Arnold-Chiari malformation be able to cause meningocele? I am not sure but if cerebellum is pushed in foramen magnum distal meninges may be pushed out inferiorly... What do you think?
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| Jackofknives
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I’m not sure what you meant, but Arnold-Chiari syndrom occurs as a result of spina bifida cystica not vice versa. Consequently it’s not possible to have Arnold-Chiari first to induce spina bifida.
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| virgola82
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Arnold-Chiari is not my strongest subject so I am not sure of what comes first but anyway in Arnold Chiari there is herniation of the vermis and medulla down through the foramen magnum with open inferior neural tube
So I think the right answer is C... i mean the observed cyst is explained by arnold chiari... What do you think?
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| Jackofknives
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You got to understand how Arnold Chiari is formed. Throughout life your vertebrate grows faster than spinal cord. E.g by 3rd month spinal cord is as long as verbrate, neonatally spinal cord only extend to L3, in adults it’s L1-2. If you have spinal bifida cystica, your spinal cord is fixed at the pt where the spinal herniation is, thus becoming immovable. Consequently when you grow your spinal cord cannot be dragged up but the brain is dragged downwards, result in cerebellum being pushed through the foramen magnum, thus giving rise to aqueduct stenosis and thereby hydrocephalus. Then you have Arnold Chiari formation.
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| virgola82
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thank you jack, I think I got it now.
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| hedieh
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Dear Jackofknives:
Mechanism of anencephaly & spina bifida is the same, but origin is different. We have two neuropores in embryonic life, which are two holes in neural tube, one is located in anterior or cephalade portion of embryo, failure of its closure=anencephaly
failure of closure of the other hole, which is located in the caudal or rostarl or posterior part of embryo= spina bifida, meningocele, myelomeningocele
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| hedieh
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You are right Jackofknives, I got my mistake.
Rostral=anterior, so you r right.
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| po
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yep its confusing,dictionary meaning,
Rostral=Toward the front
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| karned2
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A
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