A neural tube defect is the common
congenital anomaly incidence with an incidence of 6.57-8.21 per 1000 livebirths.1 Patients usually present early because of obvious swelling or due to neurological deficit.However, neglecting the obvious cystic swelling on the back till adulthood is rare. Rao and Dinakar  reported a case of meningocoele in 25-year-old man.2 In our department 28 cases of spina bifida cystica were treated over the period of 7 years. The age of the patients ranged from 1 day old to 6 years of age except for this case.
A 20-year-old male patient had a swelling in the lumbosacral region since birth. It was increasing in size slowly with the growth of the patient. There were no neurological symptoms and no bowel bladder involvement.
On examination there was a cystic swelling over the lumbosacral region in the midline, approximately of size 10 x 15 x 6 cms. It was brilliantly transilluminant with no evidence of neural element within. There was no cough impulse. Overlying skin was stretched. No neurological deficit being noted.
Plain roentgenogram of the lumbar spine showed sacralisation of the fifth lumbar vertebra and spina bifida of L4 and L5. The sacral canal was open posteriorly. CT scan of lumbosacral spine was suggestive of meningocoele at L4-L5 region with open spinal canal with no neural component inside the cystic
Fig. 1 : Showing Lumbosacral meningocoele
in an adult patient
Fig. 2 : Showing positive transillumination in
Under general anaesthesia a transversely elliptical incision was made over the swelling. The skin edges were undermined and the neck of the sac was isolated. On opening the sac cerebrospinal fluid escaped. There were no nerves in the sac, which was communicating with the spinal subarachnoid space through an opening of 2 mm diameter. The sac was excised and the neck closed with continuous prolene. Rectangular flap of fascia covering the sacrospinalis were raised on both sides and repair was done by double breasting the flaps over the spinal defect. The wound was closed in layers. Postoperative recovery was uneventful. Patient was discharged on 14th postoperative day. Patient was symptom free on his 3rd year follow up visit.
Lumbosacral meningocoele in an adult patient is rarely found. Only two cases have been reported in the literature and this is the third case to be reported. Although rare, untreated spina bifida cystica should be included in the differential diagnosis of dorsal midline cystic lesions in adults3. Even though they appear as a simple spinal meningocoele clinically, preoperative MR imaging and CT are necessary and helpful in the precise diagnosis and surgical planning.3
- Cherian A, Seena S, Bullock RK, Antony AC. Incidence of neural tube defects in the least-developed area of India: a population-based study. Lancet 2005; 366 (9489) : 930-1.
- Rao SB, Dinakar I. Lumbosacral meningocele in an adult – a case report. J Postgrad Med 1971; 17 (2) : 91-2.
- Akay KM, Gonul E, Ocal E, Timurkaynak E. The initial treatment of meningocele and myelomeningocele lesions in adulthood: experiences with seven patients. Neurosurg Rev 2003; 26 (3) : 162-7.
NON-MOTOR SYMPTOMS OF PARKINSON’S DISEASE
‘Non-motor symptoms dominate the clinical picture of advanced Parkinson’s disease and contribute to severe disability impaired quality of life, and shortened life expectancy’
Parkinson’s disease is one of the most prevalent and best studied movement disorders; however, a host of non-motor symptoms associated with the disease can appear before the motor symptoms and have substantial effects on quality of life and life expectancy. The treatment of sleep disturbances, neuropsychiatric symptoms, dysautonomia, and other symptoms has received little attention in published research. In the March issue of The Lancet Neurology, K Ray Chaudhuri and colleagues outline the potential pathological mechanisms for non-motor symptoms, highlight the scale of the problem, and discuss possible approaches to management.
Lancet Neurol 2006; 5 : 235.
*Lecturer, **Research Assistant, Department of Surgery; ***Resident, Department of Radiology; +Associate Professor in General Surgery, IGMC, Nagpur.