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Picture of the Month

James A. Waler, MD; Walter W. Tunnessen Jr, MD
Am J Dis Child. 1992;146(7):835-836. doi:10.1001/archpedi.1992.02160190067022.
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Denouement and Discussion 

Occult Spinal Dysraphism  Spinal dysraphism refers to developmental lesions of the spine that may involve one or more of the following structures: spinal cord, vertebrae, and overlying muscle or skin. Because the skin and the nervous system are derivatives of the embryonal ectoderm, abnormalities of these structures may be expected to occur together. Lesions result from incomplete fusion or malformation of these midlying structures as the neural groove closes to form the medullary tube.Although meningomyeloceles are readily recognizable defects, many other forms of spinal dysraphism are not as easily identified. Most children with spinal dysraphism have cutaneous markers indicating underlying abnormalities. In one review1 of 200 cases of spinal dysraphism, 51% of the patients had cutaneous markers. Others have reported cutaneous markers in 71% to 100% of cases.2

Manifestations  The most common cutaneous markers of occult spinal dysraphism occur along the craniospinal axis and


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