Updated: 2/27/2018

CNS Development

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  • Overview
    • CNS development (week 3)
      • neuroectoderm (a subtype of ectoderm) → neural plate → brain and spinal cord
    • Neural tube gives rise to
      • forebrain (prosencephalon)
        • telencephalon
          • cerebral cortex, lateral ventricles, caudate, putamen, hippocampus, olfactory bulbs
        • diencephalon
          • thalami, mammillary bodies, neurohypophysis, pineal gland, retina, optic nerve, chiasm, and tract
      • midbrain (mesencephalon)
      • hindbrain (rhombencephalon)
        • metencephalon
          • pons, cerebellum
        • mylencephalon
          • medulla
  • Neural tube defects
    • Failure of neuropores to fuse during week 4
      • vertebral arches do not fuse resulting in a connection between amnionic cavity and spinal canal
      • defect tends to occur in lumbosacral region
      • can be detected by testing maternal blood for ↑ α-fetoprotein (AFP)
        • if elevated and neural tube defect is present, then amniocentesis will show ↑ α-fetoprotein (AFP) and ↑ acetylcholinesterase
      • associated with maternal folate deficiency commonly caused by:
        • low folic acid intake during pregnancy
        • medications that interfere with folate utilization
          • Valproate, methotrexate, sulfasalazine, phenytoin
    • Spina bifida oculta
      • least severe variation with dura intact and no herniation
      • tuft of hair in lumbosacral region
    • Spina bifida with meningocele
      • only meninges herniate through spinal defect forming a CSF filled sac, but spinal cord remains in spinal canal
    • Spina bifida with meningomyelocele
      • meninges and spinal cord herniate through defect

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(M1.EB.17.4753) A 25-year-old G1P1 with a history of diabetes and epilepsy gives birth to a female infant at 32 weeks gestation. The mother had no prenatal care and took no prenatal vitamins. The child’s temperature is 98.6°F (37°C), blood pressure is 100/70 mmHg, pulse is 130/min, and respirations are 25/min. On physical examination in the delivery room, the child’s skin is pink throughout and he cries on stimulation. All four extremities are moving spontaneously. A tuft of hair is found overlying the infant’s lumbosacral region. Which of the following medications was this patient most likely taking during her pregnancy?

QID: 108832

Lithium

13%

(26/198)

Ethosuximide

6%

(12/198)

Warfarin

3%

(5/198)

Gentamicin

3%

(6/198)

Valproic acid

72%

(142/198)

M 2 C

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(M1.EB.13.6) A 24-year-old female with a history of recurrent infections, bipolar disorder, and no prenatal care gives birth to a male infant. On physical exam in the delivery room, you observe a tuft of hair over the infant's lumbosacral region. Which of the following drugs was this mother most likely taking during pregnancy?

QID: 101900

Chloramphenicol

3%

(13/445)

Gentamicin

2%

(7/445)

Lithium

22%

(98/445)

Valproate

66%

(295/445)

Folic acid

5%

(23/445)

M 1 E

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