A case report of caudal regression syndrome associated with an intraspinal arachnoid cyst

Caudal Regression Syndrome with Pressure Ulcers of the Foot: A Case Report

Caudal Regression Syndrome (CRS) is a rare disorder which consists of abnormalities in the lumbosacral spine, rectum, urinary system and lower limbs. These abnormalities also include orthopaedic deformities, such as hip dislocation, knee-flexion contracture with popliteal webbing and talipes equinovarus. Because of the rarity of this condition, few medical personnel are aware of it. Here, we present a case of CRS in a 15-year-old girl with pressure ulcers on the lateral malleolus and plantar surface of the foot, which had come into contact with the wheelchair footrest. Although the foot ulcers healed after off-loading, the ulcer on the lateral malleolus did not heal with conservative treatment and was covered by a lateral supramalleolar flap after debridement. Stable coverage and good contours were present at 18 months postoperatively. CRS patients may have a risk factor for developing pressure ulcers of the foot due to the characteristic lower limb deformities and a loss of sensation. Preventive foot care measures such as off-loading devices combined with modern dressings should be applied as routine when the medical personnel is to attend such patients.

A case of caudal regression syndrome: walking or sitting?

Caudal regression syndrome (CRS) is a congenital disorder which is seen vertebral anomalies in varying degrees from lower thoracic spineto the level of the coccyx. We present a case of CRS which is not intended operation for orthopedic deformities considering functionality. 2, 5 year-old girl referred to our clinic with complaints about walking disability, knee and foot deformities. Patient's mother with unregulated diabetes did not have a history of drug use, radiation exposure and serious illness during pregnancy. Diagnosis had been put during antenatal follow-ups. On physical examination, her lower extremities were hypoplastic and had no muscle activity. Her hips were flexed and abducted, but did not have contractures. Her knees had 75 degrees of flexion contractures with popliteal webs and feet had equinovarus deformity. Frog belly was present due to abdominal muscles weakness. Also hypoplasic labia majora has been identified. In lumbar MRI, spinal cord was terminated at 6th thoracic (T6) vertebrae and the last solid vertebrae level was at T10. Patient who has been following by urology with clean intermittent catheterization had also severe urological problems including horseshoe kidney, neurologic bladder, vesico-ureteral reflux and grade 2 hydronephrosis. Orthopedic consultation was made for her deformities. They decided that ambulation unexpected patient's knee flexion contractures were helping sitting balance. Because of this operation was not considered. Prognosis, treatment options, strength exercises for upper extremities, skin care were told to parents and patient was taken to follow. CRS is a rare congenital abnormality which is associated with orthopedic deformities, as well as urological, anorectal and cardiac malformations. Treatment requires a multidisciplinary approach. It should not be forgotten that purpose of rehabilitation is not to correct all deformities but increase the functionality of everyday life.

Neonatal anterior cervical arachnoid cyst: case report and review of the literature

OBJECTIVE

Anterior cervical arachnoid cysts are rare in the pediatric population, with only 16 cases reported. We present the first case of an anterior cervical arachnoid cyst in a neonate and review the literature on pediatric cervical arachnoid cysts.

CLINICAL PRESENTATION

A 16-day-old baby girl with a history of myelomeningocele repair progressively developed symptoms of upper extremity weakness over the course of 2 weeks. Magnetic resonance imaging (MRI) demonstrated a compressive arachnoid cyst extending from C2 to C7.

INTERVENTION

The child was taken for posterior cervical laminoplasty and cyst fenestration. Intraoperatively, diffuse cervical arachnoiditis was noted. Rapid improvement in upper extremity paresis was noted within 24 h of surgery, and MRI confirmed decompression of the cyst. However, flaccid upper extremity paresis recurred within 2 weeks. MRI confirmed recurrence of the anterior cervical arachnoid cyst. The child was taken for a secondary fenestration and stenting of the cyst. Only partial improvement in arm function was noted by 1 month following reoperation.

CONCLUSION

Arachnoid cysts can be effectively treated with surgical fenestration, shunting, and complete or partial excision. Rapid identification and treatment results in improvement in myelopathic symptoms; however, the most efficacious treatment modality remains unknown. Of the 17 cases of anterior cervical arachnoid cysts reported in the literature, 11 (65%) have had either prior myelomeningocele repair or a history of spinal trauma. Anterior cervical arachnoid cysts should be considered in the differential diagnosis of acute onset myelopathy in the pediatric population especially in cases with a history of spinal trauma or myelomeningocele repair.

Caudal regression syndrome associated with the white matter lesions and chromosome 18p11.2 deletion

Caudal regression syndrome (CRS) is a rare combination of congenital abnormalities characterized by caudal vertebral agenesis/dysgenesis that is usually associated with congenital anomalies of spinal cord, gastrointestinal and genitourinary organs. Although the exact teratogenic mechanism is not known, same environmental, e.g., hyperglycemia and genetic factors appears to play a crucial role in this fetopathy. Herein, we report an unusual case of CRS associated with unspecific white matter lesions and 18p-syndrome manifested by congenital ptosis, hypothyroidism, facial dysmorphy and chromosome 18p11.2 deletion.