Cervical myelocystocele: rare presentation of spinal dysraphism

Abstract

INTRODUCTION Cervical myelocystocele (CM) is a none common variant of closed spinal dysraphisms. It is caused by partial dorsal mye-loschisis at the late stage of neurulation [1, 2]. CASE REPORT The mother of our patient was a 26-year-old woman, whose pre-existing medical conditions include hereditary xerocytosis and severe gastro-esophageal reflux (GERD). She was unable to use folic acid supplement for more than 1 week because of GERD. Her prenatal ultrasounds were done at 12, 18, 26 and 32 weeks of postmenstrual age and reported as normal. Our patient was delivered at term by spontaneous vaginal delivery and noted to have skin-covered soft mass at C5–C7 along spinal column (Fig. 1a). There was a divot with no fluid leakage. Expect for this finding, his general examination was unremarkable. The patient could move all limbs spontaneously; tone was normal, and no spasticity was present. Magnetic-Resonance Imaging (MRI) of the brain, cervical and lumbar spine was requested. Spinal MRI detected a defect in the posterior element of the spinal canal at the level of C5 vertebra representing spina bifida (Fig. 1b). Small stalk arising from the posterior aspect of the thecal sac was crossing through the spina bifida into the dome of meningocele posteriorly at the same level. The rest of the spinal cord Figure 1: (a) Clinical presentation at birth skin-covered mass measures 12 × 8 × 12 mm. (b) MRI on day of life 5, showing spina bifida at the level of C5.