ly more than 2 1, female to male (18:350).
The assorted symptoms of spina bifida occulta may be cutaneous, neurological or orthopedic in nature. Cutaneous signs may include a very hairy patch (hypertrichosis) resembling a horse's tail situated at about midline. In addition, midline lumbosacral port wine angiomas are also frequently associated with the disorder. Other possible signs include pigmented nevi (red to brownish mottled patches) and atretic meningoceles (skin abnormalities consisting of a central thin white area surrounded by a periphery of red, pink or brown), as well as subcutaneous lipomas and dimple like depressions (18:352 353).
Neurological manifestations of spina bifida occulta include muscle weakness and gait disturbance, often with onset at about two years of age (i.e., when the child begins to walk). There may also be unilateral lower extremity muscle atrophy and, possibly, a short leg. Deep tendon reflexes tend to vary considerably; they can be either normal, increased, hypoactive, or completely absent. Sensory examination is generally unreliable.
In addition, mothers may complain of their child's enuresis or inability to toilet train. Moreover, there may be complaints of urine dribbling with abdominal pressure, stress incontinence or overflow incontinence.
The most frequent orthopedic finding in spina bifida occulta involves the foot. This deformity can be highly variable (16:797). It may occur as a "club foot," with plantar flexion that deviates medially (18:353). There may also be "claw toes."
Abnormalities of gait are usually due to the foot deformity, the shortened leg, or muscular weakness (15:174). Usually there is a complaint of pain secondary to the abnormal gait. James and Lassman described the gait as an "elevation of the first metatarsal head as though something were underneath the foot with the great toe flexed (16:797 798)."
These deformities result from neuronal defici...