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Peds > Brain pt 2 > Flashcards

Brain pt 2 Flashcards

1
Q

what defines a premature baby?

A

a baby born brfore 37 weeks GA

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2
Q

what is seen in a sagittal midling scan of an immature brain?

A

The midline cystic cavum septum pellucidum (CS) and cavum vergae (CV) are prominent in the premature infant

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3
Q

what is cavum vergae?

A
  • extension of CSP
  • persistence of embryological fluid- filled space between the leaflets of the septum pellucidum and is a common anatomical varient
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4
Q

where is cavum vergae located?

A

0 on coronal view located between bodies of lateral ventricles

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5
Q

when does closure of the cavum vergae start?

A

6 month gestation

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6
Q

Superior to the cavum is the?

A
  • hypoechoic corpus callosum

- 3rd and 4th ventrivles, with 4th ventricle seen as a triangular lucency indenting the vermis

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7
Q

what is visible anterior to the vermis?

A

the cisterna magna

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8
Q

what is seen anterior to the 4th ventricle?

A

midbrain

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9
Q

what is the posterior approach?

A
  • sagittal imaging plane through the posterior frontanelle

- coronal plane is obtained by rotating the transducer 90 degrees

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10
Q

Ventricular asymmetry. Coronal scan shows the left lateral ventricle larger than the right. Is this normal?

A

yes this is a normal varient

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11
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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12
Q

what is an Intracranial hemorrhage?

A
  • one of the main indications for u/s and a major cause of morbidity and mortality in premature infant
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13
Q

what is a Germinal Matrix Intraventricular Hemorrhage (GM-IVH) ?

A
  • Majority occur within 3 days of life in premature infants
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14
Q

what is a germinal matrix?

A
  • fetal structure
  • fine network of blood vessels and primitive neural tissue
  • located in subepindymal region of lateral ventricles
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15
Q

where us the most prominent portion of germinal matrix?

A
  • lies in caudothalamic groove

- between caudate nucleus and thalamus

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16
Q

Germinal matrix structure?

A
  • has immature fragile blood vessels with poor supporting connective tissues
  • highly susceptible to pressure and metabolic changes, which lead to rupture of vessels
17
Q

when does Germinal matrix reach its greatest size?

A
  • at 23-24 weeks
  • then it starts to regress
  • completely incolutes by 36 weeks
18
Q

Germinal matrix is rare in term babies T or F?

A

true because it completely involutes by 26 weeks

19
Q

Ependyma?

A

thin epithelium-like lining of theventricular systemof thebrainand thecentral canalof thespinal cord

20
Q

intracranial hemorrhage grade 1?

A

subepindymal hemorrhage

21
Q

intracranial hemorrhage type 2?

A

IVH without ventricular dialation

22
Q

intracranial hemorrhage type 3?

A

IVH with ventricular dialation

23
Q

intracranial hemorrhage type 4?

A
  • intraparnchymal hemorrhage with or withough ventricular dilation
24
Q

Germinal Matrix Hemorrhage (SEH): Grade I primary site?

A

caudothalmic groove (CTG)

25
Q

3 steps to scanning a Germinal Matrix Hemorrhage (SEH): Grade I?

A

A: Parasag scan through the area of the caudothalamic groove shows a focal area of increased echogenicity (arrow)

B: Cor. scan - bilateral echogenic foci at the CTG (arrows).

C: Resolving grade I hemorrhage.
The same infant several weeks later shows clot has undergone cystic liquefaction (arrow).

26
Q

there are long tern neurologic complications with a Germinal Matrix Hemorrhage (SEH): Grade I T or F?

27
Q

Grade II Hemorrhage characteristics?

A
  • GMH ruptures through epyndymal lining and enters ventricles
  • no ventricular dilation
28
Q

Grade II Hemorrhage clot?

A
  • Clot can adhere to normal CP making it appear irregular and thick.
  • This may be difficult to see on ultrasound
  • Doppler will show flow in CP, no flow in clot
29
Q

in Grade II Hemorrhage where does blood most often accumulate?

A

in the most dependent part of ventricle- occipital horn

30
Q

occipital horns are best seen through?

A

posterior frontanelle

31
Q

Grade II Hemorrhage on u/s?

A
  • echogenic

- material in occipital horn

32
Q
A

grade III hemorrhage

A- Parasag scan shows blood-filled lateral ventricle with clot filling the entire ventricle and forming an echogenic cast of the ventricle (arrow)

B- Coronal scan shows clot in both lateral ventricles with hydrocephalus (arrow)

C- Same patient 14 days later shows evolution of clot. Coronal scan shows area of liquefaction of clot (arrow)

D- Parasag scan shows some retraction of the intraventricular clot.

33
Q
A

Grade III hemorrhage

A- Coronal scan posteriorly

  • Dilation of the lateral ventricles
  • Echogenic material (blood clot) in the ventricles

B- Coronal scan in the same infant posteriorly
- The lateral ventricles are dilated with large amount of intraventricular hemorrhage which, on the - - right, is taking the shape of the ventricle (arrow)

C- Sagittal scan of the left lateral ventricle.

  • The blood clot has settled posteriorly and is lying primarily in the occipital horn
  • The echogenic CP can be seen separate and anterior to this (arrow).
34
Q

Grade IV Hemorrhage?

A
  • Parenchymal involvement with or without ventricular dilatation
  • Most common in frontal and parietal lobes
  • Resorption of hemorrhagic area may lead to formation of porencephaly
35
Q

Porencephaly?

A
  • fluid filled space that have replaced normal brain parenchyma due to destructive process
  • These cysts rarely resolve
36
Q

long term complications of grade IV hemorrhage?

A
  • cerebral palsy
  • developmental delays
  • seizures

Peds (18 decks)

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