deletions | additions       diff --git a/discussion.md b/discussion.md  index fd17a17..ce8577b 100644  --- a/discussion.md  +++ b/discussion.md 
...
tone, or numbness and paresthesia in the lower sacral  dermatomes.\cite{11956924} Also fluid shifts between the sac and the spinal subarachnoid space can cause intermittent low or high-pressure headache, nausea and vomiting related to changes in body position.\cite{6828997} As a result of this nonspecific symptoms, the diagnosis can be difficult and occasionally can be confused with other entities.    The diagnostic tests include several imaging studies like plain radiograph which shows the curved appearance of the residual sacrum, scalloped beneath the defect, this finding is considered as almost pathognomonic, and is present in 50% of cases.\cite{3335662} Abdominal ultrasound could reveal the presence of the intra-abdominal cystic abnormality, careful examination should be made to avoid misdiagnosis with cysts in other locations, a typical example of this is the confusion with ovarian cysts, as happened with our patient, and has been described in other reports.\cite{16673368}\cite{23486628} ... CT-scans are useful to display bony anomalies and lumbar erosions[6]. Intrathecal contrast enhanced CT scanning is the diagnostic procedure of choice, since demonstrates the communication between the meningocele and the subarachnoid spaces [13]. However, this method usually is descarted as  is invasive and has the disadvantage of ionizing radiation. MRI is a safe, rapid, and noninvasive imaging method with multiplanar imaging capability, and the advantage that  it can also show any associated small tumors. [13]. tumors.[13  - approaches