title: [Abnormalities in the central nervous system and alterations in the upper limbs in patients with myelomeningocele].
abstract: BACKGROUND
  Myelomeningocele is a neural tube defect resulting in motor and sensory deficit below the level of the lesion, bowel and neurogenic bladder, sexual dysfunction, cognitive dysfunction, neurodevelopment delay and motor skills disability. During the past decades, hand function impairment has been described in myelomeningocele patients, probably due to central nervous system abnormalities. AIM. To determine the occurrence of upper limb impairment and additional central nervous system abnormalities in patients with myelomeningocele.
  
  
  METHODS
  A transversal study including 33 patients with myelomeningocele, 6 years and older, referred to pediatric rehabilitation program at Sarah Network of Rehabilitation Hospital (Fortaleza, Brazil), and 33 control subjects. All patients underwent brain and spinal cord magnetic resonance imaging.
  
  
  RESULTS
  Hydrocephalus, Chiari type II malformation with or without kinking of the medullocervical junction, hydrosyringomyelia, spinal cord and brain atrophy were the most common central nervous system abnormalities. Dysmetria, evaluated by the Index-Index Test, was exhibited by 87.9% of the patients and 21.2% of them exhibited dysdiadochokinesia. The mean hand grip strength of the myelomeningocele group was significantly lower compared with the control group (p < 0,001).
  
  
  CONCLUSIONS
  High occurrence of upper limb dysfunction and additional central nervous system abnormalities was detected in patients with myelomeningocele, supporting previous studies. Further investigation is still necessary to elucidate the upper limb impairment impact on the daily live activities of the patient with myelomeningocele.
authors.affiliation: Servicio de Fisioterapia, Programa de Rehabilitación Infantil, Centro de Reabilitacao Sarah Fortaleza, Fortaleza, Brasil. egmarlongo@hotmail.com
authors.forename: E
authors.initials: E
authors.lastname: Longo-Araújo de Melo
authors.forename: A
authors.initials: A
authors.lastname: Castelo-Branco Araújo
authors.forename: G
authors.initials: G
authors.lastname: Silveira-Carrara
authors.forename: M
authors.initials: M
authors.lastname: Nakayama
authors.forename: D G
authors.initials: DG
authors.lastname: Fernandes-Távora
mesh_terms: D000015:Abnormalities, Multiple; D000293:Adolescent; D000328:Adult; D001132:Arm / Q000503:physiopathology*; D002490:Central Nervous System / Q000002:abnormalities*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008591:Meningomyelocele / Q000150:complications*