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Peds > brain - part 3 > Flashcards

brain - part 3 Flashcards

1
Q

intracranial pathologies? (9)

A 
Intracranial Hemorrhage  - ICH
Hydrocephalus
Cerebellar Hemorrhage
Periventricular Leukomalacia – PVL
Agenesis of Corpus Callosum
Dandy-Walker complex
Chiari Malformation
Holoprosencephaly
Intracranial Infections
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2
Q

what is Hydrocephalus?

A
  • progressive dialation of ventricular system
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3
Q

3 mechanisms of Hydrocephalus?

A
  1. obstruction to CSF outflow
  2. decreased CSF absorption
  3. CSF overproduction
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4
Q

what can cause Hydrocephalus?

A

hemorrhage grade 3 and 4

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5
Q

Hydrocephalus clinical signs?

A
  • increasing head size
  • bulging of the anterior frontanelle
  • separation of cranial sutures
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6
Q

why are serial u/s required to monitor the progression of Hydrocephalus?

A

because bradycardia, apnea, and increased ICP appear days or weeks later

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7
Q
A

post hemorrhagic hydrocephalus

  • shows grade III hemorrhage
  • hydrocephalus with clot in lateral and 3rd ventricle
  • ependymal lining of ventricles in increased in echogenicity consistent with ependymitis
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8
Q

what is ependymitis caused by?

A
  • blood products/ chemical ventriculitis
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9
Q

Infants with progressive hydrocephalus and increased ICP may require ?

A

placement of a shunt

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10
Q

Hydrocephalus u/s scan?

A
  • Doppler used to identify infants with increased ICP
  • Compression of anterior fontanelle with transducer while obtaining a spectral Doppler from pericallosal artery (anterior cerebral a.)
  • Compress gently for 3 – 5 sec
  • Do not compress if you see reversal of flow without compression
  • Stop compression if heart rate goes down.
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11
Q

Cerebellar hemorrhage clinically?

A
  • may be silent and found on routine cranial U/S
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12
Q

Cerebellar hemorrhage approach?

A
  • mastoid frontanelle approach is used
  • cerebellum is in far field in anterior frontanelle scan
  • highly echogenic tentorium is avoided
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13
Q

posterior fossa

A

Normal posterior fossa structures obtained via the mastoid fontanelle

Coronal sonogram shows a normal

  • 4th ventricle (4)
  • cerebellar hemispheres (*)
  • midline vermis (V)
  • cisterna magna (CM).
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14
Q
A

Coronal image shows large echogenic hemorrhage in the right cerebellar hemisphere (arrows).

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15
Q
A

Coronal scan shows clot (c) in dilated fourth ventricle (4).

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16
Q

Periventricular Leukomalacia (PVL)?

A
  • Hypoxic-ischemic brain injury
  • Hypoxia – lack of O2
  • Ischemia – lack of adequate blood flow
  • Leukomalacia – softening of white matter
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17
Q

common sites for Periventricular Leukomalacia (PVL)?

A
  • White matter adjacent to peritrigonal area of lateral ventricles
  • Frontal cerebral white matter anterolateral to frontal horns
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18
Q

Periventricular Leukomalacia (PVL) on u/s?

A

SONO – not very reliable
Increased echogenicity in affected area
Bilateral and symmetric
Echogenicity should not be > choroid plexus
Difficult to differentiate from periventricular blush
Later changes to PVL
Formation of cysts as a result of necrosis and cavitation

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19
Q

Periventricular Leukomalacia (PVL) long term affects?

A

cerebral palsy
developmental abnormalities
intellectual and visual impairment

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20
Q
A

Periventricular Leukomalacia in Premature Infant

21
Q
A

evolving PVL

22
Q
A

agenesis of corpus callosum

23
Q

Agenesis of the Corpus Callosum?

A
  • Complete or partial absence of the hypoechoic band superior to 3rd ventricle
  • Frontal horns widely separated and angled laterally
  • Occipital horns have parallel orientation and a teardrop shape
  • Enlargement of posterior (occ.) horns (colpocephaly)
  • Radial arrangement of sulci and gyri above 3rd ventricle – sunburst sign
  • Absent CSP*, high and enlarged 3rd ventricle
24
Q

sunburst sign is associated with?

A

agenesis of corpus callosum

25
Q

Dandy-Walker Malformation?

A

A spectrum of anomalies of posterior fossa:

  • Cystic dilatation of 4th ventricle
  • Superior elevation of the tentorium
  • Absence of vermis
  • Small cerebellar hemispheres
  • Hydrocephalus
26
Q

Dandy-Walker Malformation is associated with?

A

Associated with many other cerebral (agenesis of CC, holoprosencephaly) and non-cerebral anomalies (cystic renal dx, chromosomal and cardiac)

27
Q
A

dandy walker malformation

28
Q

Chiari Malformation most common type?

29
Q

Chiari Malformation is almost always associated with?

A

myelomeningocele

30
Q

Chiari Malformation on sono?

A

Hydrocephalus with prominent massa intermidia

Inferior pointing of frontal horns – “bat wing”

Downward displacement of cerebellum and 4th v. into spinal canal

Non-visualized cisterna magna
Small posterior fossa

Low and displastic tentorium

Colpocephaly (large occ. horns)
Complete or partial CC agenesis

31
Q
A

chiari II malformation

32
Q

Vein of Galen Malformation?

A

Most common intracranial vascular anomaly in neonate

Midline cerebral AV malformation that causes dilatation of v. of Galen

Anterior and posterior cerebral aa. feed the malformation

Decreased blood supply to brain – atrophy and calcifications of brain

33
Q

what is the most common intracranial vascular anomaly in neonate?

A

vein of galen malformation

34
Q
A

vein of galen malformation

35
Q

Holoprosencephaly?

A

Spectrum of congenital malformations that result from a disorder of diverticulation in which the primitive forebrain (prosencephalon) fails to divide into two separate cerebral hemispheres

36
Q

3 kinds of holoprosencephaly?

A

alobar- most severe
semilobar
lobar- least severe

37
Q

holoprosencephaly result?

A 
Infants with alobar type are stillborn or die shortly after birth
Severe facial anomalies
Close set eyes – hypotelorism
Cyclopia
Proboscis – nose on forehead
Cleft lip/palate
38
Q

Alobar holoprosencephaly?

A

There is a thin pancake like primitive cerebrum covering a horseshoe shaped midline monoventricle

Missing:
Corpus callosum
Third ventricle
Interhemispheric fissures
Thalami are fused
39
Q

semilobar holoprosencephaly?

A

Incomplete forebrain division with partial separation of the cerebral hemispheres posteriorly
Single ventricle with occipital and temporal horns formed
Falx may be present
3rd v. is small or absent

40
Q
A

alobar holoprosencephaly

41
Q

Most common neonatal congenital infections are referred to as?

A

TORCH complex

42
Q

what is TORCH?

A 
T  Toxoplasmosis
O  Others
R  Rubella
C  Cytomegalovirus CMV
H  Herpes Simplex
43
Q

INTRACRANIAL INFECTION?

44
Q

Most common intracranial infection?

A

CMV

  • Toxoplasmosis is 2nd
45
Q

intracranial infection if trasmited via?

A

placenta

  • herpes transmits at birth from contact with vaginal lesions
46
Q

how are CNS infections diagnosed?

A

clinically

47
Q

u/s role in intracranial infection?

A

used to determine complications

  • Parenchymal calcifications
  • Lenticulostriate vasculopathy
48
Q
A

cytomegalovirus infection

49
Q
A

Lenticulostriate Vasculopathy

Peds (18 decks)

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