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PBL [#2] Maternal Flowchart, Khalid - Coggle Diagram
PBL [#2] Maternal Flowchart
Takes Antieplipetics before and during pregnancy (specifically valproate and carbamazapine)
Folate Deficiency due to long term usage
affect neural tube development
Increased glutamate
Increased NMDA and AMPA receptor stimulation
Increased cation influx
Depolarization of the neuron
Increased neuron firing
Seizure
has had epilepsy since age 10
epilepsy under control. no tonic/clonic seizures
had jerks involving her upper limb yesterday morning while still conscious
Khalid
born an 38 weeks with a defect in lumbosacral region consistent with a myelomeningocele.
decreased spontaneous movement of the lower limbs and decreased tone
The anus was patulous and oozing meconium. absent tone in the anal sphincter and faecal incontinence. not feeding well
On day 2, CT scan showed mildly dilated ventricle.
On day 3, the skin and the meningeal defect were closed.
At 14 days, Khalid's head circumference had increased to 37cm.
Fontanelles felt full and suture lines were separated. He was lethargic
Reduced flow and absorption of CSF into specialized blood vessels of arachnoid villi
CSF accumulation in the 4th ventricle
Dilation of 4th ventricle with build up of excess fluids and increased head circumference (hydrocephalus)
Patulous of the anus, absent anal tone, and faecal incontinence is caused by the diastasis of levator ani muscles due to damage sacral plexus
Lack of bowel innervation due to lumbar nerves damage lead to oozing meconium and feeding difficulties
The part of the spinal cord and the nerves in the sac are damaged, which in this case lumbarsacral
resulting in weakness and/or loss of sensation to the part of the body below where the sac is located.
Anticonvulsants which are valproate and carbamazepine interfere with folate metabolism leading to folate deficiency
increased plasma and tissue concentration of homocysteine, that is responsible for the observed defects through widespread neuronal apoptosis
Outpouching of meninges and parts of the spinal cord through the vertebral bone
Myelomeningocele