Differential Diagnosis for Tuft Hair in Sacral Crease
The presence of tuft hair in the sacral crease of a baby can be an indicator of an underlying spinal dysraphism, a condition where there is an abnormality in the development of the spine. Here's a differential diagnosis organized into categories:
Single Most Likely Diagnosis
- Spina bifida occulta: This condition is characterized by a small gap in the spine but without the protrusion of the spinal cord or meninges through the gap. The presence of tuft hair in the sacral area is a common cutaneous marker for spina bifida occulta.
Other Likely Diagnoses
- Dermal sinus: A congenital anomaly that results from an abnormality during neural tube formation, leading to a tract or sinus that connects the skin to the spinal canal or spinal cord. Tuft hair can be a sign of a dermal sinus.
- Lipoma or lipomyelomeningocele: These are types of spinal dysraphism where a fatty mass is associated with the spinal cord. Cutaneous signs like tuft hair can indicate the presence of such a lesion.
Do Not Miss Diagnoses
- Tethered cord syndrome: Although not directly indicated by tuft hair alone, the presence of other cutaneous signs along with tuft hair in the sacral area could suggest tethered cord syndrome, where the spinal cord becomes attached to the spine and can lead to serious neurological problems if not addressed.
- Meningocele or myelomeningocele: These are more severe forms of spina bifida where the meninges or spinal cord protrude through an opening in the spine. While tuft hair alone might not directly indicate these conditions, any suspicion of spinal dysraphism warrants thorough investigation to rule out these serious conditions.
Rare Diagnoses
- Neurenteric cyst: A rare congenital anomaly that results from an abnormal connection between the intestine and the spinal canal during embryonic development. Cutaneous signs like tuft hair could potentially be associated with this condition, although it is much less common.
- Diastematomyelia: A type of spinal dysraphism where a part of the spinal cord is split, often by a bony or fibrous spur. This condition can present with cutaneous signs, including tuft hair, but is less common than other forms of spinal dysraphism.