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      Late-Onset Tethered Cord Syndrome in a Patient with Spina Bifida: A Case Report

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          Abstract

          Tethered cord is a clinical syndrome associated with short and thick filum terminale. It can occur because of congenital or acquired reasons and can lead to progressive neurological deficits. A thorough medical history, physcial examination, imaging, and electrophysiological tests are heplful in its diagnosis.

          An 11-year-old patient with a prior diagnosis of spina bifida was operated for pes ekinovarus at the age of 1.5 years. The patient visited our physical medicine and rehabilitation polyclinic with complaints of pain and weakness in the left ankle and region around the knee. She had been suffering from walking disruption, thinning of leg muscles, and pain for past 1 year. After imaging, a diagnosis of tethered cord syndrome was made.

          Follow-up of patients diagnosed with spina bifida during growth period is important to prevent complications such as syringomyelia and tethered cord syndrome.

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          Differential diagnosis for cervical spondylotic myelopathy: literature review.

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            Tethered cord syndrome in adulthood.

            The standard treatment for tethered cord syndrome (operative vs nonoperative management) that presents in adulthood remains controversial. A comparative study of tethered cord syndrome in adulthood is needed.
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              Defining the line between hydromyelia and syringomyelia. A differentiation is possible based on electrophysiological and magnetic resonance imaging studies.

              With the frequent use of magnetic resonance imaging (MRI), patients with subtle and diffuse symptoms due to small syrinx cavities increasingly present to neurosurgical care. In this respect, a dilated central canal, hydromyelia, must be separated from patients with true syringomyelia with an underlying disorder, as they do not share clinical and radiological features. We hypothesize that a differentiation of these two entities with distinct diagnostic tools is possible. To describe the entity of hydromyelia, we excluded all patients from the syringomyelia database (n = 142) with any obvious cause of a syringomyelia, any objective neurological deficits on clinical examination, pathological results on electrophysiological monitoring (SSEP, MEP, silent periods) or a widening of the spinal cord cavity of more than 6 mm on MRI [routine acquisitions with FLAIR, T1/T2-weighted images, Cine and CISS (constructive interference in steady-state) studies]. Life quality was assessed through SF-36 questionnaires and an individualized questionnaire for the clinical history, pain and alternative therapies. Forty patients (15 males/25 females) matched the criteria of a hydromyelia. With a mean age of 36.7 years (range 11-62), they almost all presented with pain (79%) or dysaesthesia of the limbs, with some having been an incidental finding (10%). Over a follow-up time of 36.9 months (range 6-93) there was no neurological or radiological deterioration. Patients with a hydromyelia do not share clinical or radiological characteristics with patients harbouring a true syringomyelia. As hydromyelia does not represent a disease with an underlying pathology, no clinical or radiological progression has been seen. With sophisticated diagnostic tools to rule out any pathology this subset of patients can be identified.
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                Author and article information

                Journal
                Sisli Etfal Hastan Tip Bul
                Sisli Etfal Hastan Tip Bul
                The Medical Bulletin of Sisli Etfal Hospital
                Kare Publishing (Turkey )
                1302-7123
                1308-5123
                2018
                29 May 2018
                : 52
                : 2
                : 138-141
                Affiliations
                [1 ]Department of Physical Medicine and Rehabilitation, Istanbul Medipol University, Faculty of Medicine, Istanbul, Turkey
                [2 ]Department of Radiology, Istanbul Medipol University, Faculty of Medicine, Istanbul, Turkey
                Author notes
                Address for correspondence: Merve Çalkın, MD. Department of Physical Medicine and Rehabilitation, Istanbul Medipol University, Faculty of Medicine, Istanbul, Turkey Phone: +90 506 290 41 27 E-mail: mervecalkin@ 123456hotmail.com
                Article
                MBSEH-52-138
                10.14744/SEMB.2017.64936
                7315062
                5a593933-61df-4b9b-9b57-f0090a27da4d
                Copyright: © 2018 by The Medical Bulletin of Sisli Etfal Hospital

                This is an open access article under the CC BY-NC license ( http://creativecommons.org/licenses/by-nc/4.0/).

                History
                : 17 January 2017
                : 23 January 2017
                Categories
                Case Report

                spina bifida,syringomyelia,tethered cord syndrome
                spina bifida, syringomyelia, tethered cord syndrome

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