Published online Aug 8, 2013. doi: 10.5409/wjcp.v2.i3.26
Revised: April 26, 2013
Accepted: May 7, 2013
Published online: August 8, 2013
Processing time: 99 Days and 8.7 Hours
Sacral dimples are the most common cutaneous anomaly detected during neonatal spinal examination. Congenital dermal sinus tract, a rare type of spinal dysraphism, occurs along the midline neuraxis from occiput down to the sacral region. It is often diagnosed in the presence of a sacral dimple together with skin signs, local infection, meningitis, abscess, or abnormal neurological examination. We report a case of acute flaccid paralysis with sensory level in a 4 mo old female infant with sacral dimple, diagnosed by magnetic resonance imaging to be a paraspinal subdural abscess. Surgical exploration revealed a congenital dermal sinus tract extending from the subdural abscess down to the sacral dimple and open to the exterior with a minute opening.
Core tip: Acute flaccid paralysis with sensory level necessitates a detailed examination of the back and magnetic resonance imaging spine. Sacral dimple of more than 5 mm in diameter, lying 2.5 cm above the anus, covered by hair tufts or hemangioma, has a non visualized base, or associated with abnormal neurological examination should be further evaluated by radiology for a hidden sinus that could be a source of infection.