title: Multiple coexistent dysraphic pathologies.
abstract: BACKGROUND
  Four distinct dysraphic anomalies were observed in a single child. While combinations of such anomalies are well recognised, quadruple dysraphic pathology, nevertheless, is extremely uncommon. To our knowledge, no previous cases have been reported in the literature.
  
  
  METHODS
  We present the management of a child with a concurrent segmental meningocele, a type-1 split cord malformation (SCM) associated with hemivertebrae, lipomyelomeningoceles in each hemicord of the SCM and a terminal myelocystocele, and we review the literature on potential mechanisms of dysmorphogenesis.
  
  
  CONCLUSIONS
  Existing embryologic hypotheses for the dysraphic spectrum lack experimental evidence and studies in animal models. This case challenges the existing hypotheses and illustrates our incomplete understanding of human terminal spinal cord embryogenesis. Further studies on the morphogenetic basis for these anomalies are required.
authors.affiliation: Department of Neurosurgery, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH, London, UK.
authors.forename: Guirish A
authors.initials: GA
authors.lastname: Solanki
authors.forename: James
authors.initials: J
authors.lastname: Evans
authors.forename: Andrew
authors.initials: A
authors.lastname: Copp
authors.forename: Dominic N P
authors.initials: DN
authors.lastname: Thompson
mesh_terms: D000015:Abnormalities, Multiple; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008591:Meningomyelocele / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D009436:Neural Tube Defects / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods; D013116:Spinal Cord / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D016135:Spinal Dysraphism / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D014057:Tomography, X-Ray Computed