Faun tail - A skin marker of occult spinal dysraphism

Spinal dysraphism refers to incomplete fusion of midline structures of the embryonal dorsal median region that may affect any combination of somatic ectoderm, neuroectoderm or mesoderm. As skin and neuron tissue are of ectodermal origin, anomalies of both may occur simultaneously. Occult spinal dysraphism is characterised by skin covered lesions without exposed neural tissue. Congenital cutaneous mid line paraspinal lesions,mostly localised in the lumbosacral region are widely recognised as markers of occult spinal dysraphism. Cutaneous changes may include a lipoma, dermal sinus or cyst, hypertrichosis, dimple, hyperpigmentation, capillary hemangioma and aplasia cutis. Abnormal lumbar hypertrichosis may present as a faun tail which is a rare entity and cutaneous marker of occult spinal dysraphism. Here we present an asymptomatic infant with faun tail and split cord malformation type-1 (diastematomyelia ). A 6 month old male infant was brought to our outpatient department with an excessive amount of hair located on his lower back. The lesion had been present since birth. The child had no specific complaints. Local examination revealed a circumscribed area of hypertrichosis with coarse dark hair of varying length overlying lumbosacral region. Neurological examination was normal. As this entity is a cutaneous marker of underlying spinal anomalies x-ray and MRI spine was taken. The x-ray of dorsolumbar spine showed fusion of D12 and L1 vertebra. The MRI of dorsolumbar spine showed two hemi cords contained with its own dural sheath and seperated by osteocartilaginous medial septum extending from D12 to L3 with osseous septum L1,L2 level(split cord malformation type-1). The paediatricians are the first physicians to see such children and should be aware of the potential underlying spinal defects.