Early clinical signs and symptoms in occult spinal dysraphism: a retrospective case study of 47 patients

Since occult spinal dysraphism can lead to irreversible neurological compli cations, early diagnosis and treatment are necessary. We retrospectively st udied the presenting clinical signs and symptoms in all 47 cases of occult spinal dysraphism identified in two university hospitals in The Netherlands since 1965. Dermal sinus had been diagnosed in 12, lipomyelomeningocele in nine, and diastematomyelia in eight patients. Thirty-three patients had sy mptoms due to tethering of the spinal cord, leading to a clinical suspicion of occult spinal dysraphism in only eight cases. Twenty-eight patients had cutaneous back lesions that led to further investigation in eight cases. N ineteen patients had a small backmass leading to further examination in 13 cases. Three patients with dermal sinus presented with meningitis caused by an unusual aetiological agent. This study stresses the importance of ident ification of neurological dysfunction due to tethered cord syndrome, cutane ous back lesions, a small backmass and meningitis caused by an unusual aeti ological agent for the early diagnosis of occult spinal dysraphism. (C) 199 9 Elsevier Science B.V. All rights reserved.