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Figure 3.86. Left, photograph of another variant of a dermal sinus. Right, close-up of the same sinus. Dermal sinuses occur mid-line anywhere along the spinal cord and warrant examination of the central nervous system.

Figure 3.87. Midline skin defect with an inferior deep pilonidal dimple. MRI of the spinal column revealed a tethered spinal cord. A pilonidal sinus may connect with the underlying distal end of the spinal canal. This should be suspected when the bottom of a midline pit over the sacrum cannot be seen, if there is any fluid emerging from the depths of such a pit, or when the pit contains hairs.

Figure 3.88. Midline skin defect at the inferior aspect of the hairline of an infant with an associated dermal sinus tract. This infant had an associated lateral nasal cleft.

Figure 3.89. Anoxic encephalomalacia and hemorrhages in an autopsy specimen of a brain. Note the multiple areas of hemorrhage in the brain of this term infant.

Figure 3.90. Head ultrasound examination of an infant with schizencephaly. This is the most severe of the cortical malformations as the result of abnormal migration occurring no later than the 2nd month of gestation. There is complete agenesis of a portion of the cerebral wall leaving bilateral schisms or clefts.

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Figure 3.91. Clefts or "lips" demonstrated in the right hemisphere in the MRI of the head of an infant with schizencephaly. The lips of the clefts may become widely separated and massive dilation of the ventricles may occur. This can result in a striking degree of transillumination of the skull with an incorrect diagnosis of hydranencephaly. Infants who survive have severe seizures with marked spasticity (sometimes preceded by hypotonia), and severe retardation.

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