Cranial Ultrasound

Question 1

When do we look for hydrocephalus?

Answer 1

in term neonates and infants with large head circumferance

Question 2

Why do we scan premature infants for cranials?

Answer 2

to eval for germinal matrix bleed

Question 3

Why do we scan term neonates for cranials?

Answer 3

• hypoxic-ischemic injury after birth asphyxia
• infections
• malformations
• ECMO

Question 4

What are the 4 ventricles we assess?

Answer 4

• lateral (2)
• third
• fourth

Question 5

What is responsible for CSF production?

Answer 5

choroid plexus

Question 6

The germinal matrix is comprised of

Answer 6

primitive, highly vascular tissue that forms neurons

Question 7

After 24 weeks, the germinal matrix is confined to:

Answer 7

the caudothalamic groove

Question 8

In coronal imaging, how many standard views are there?

Answer 8

6

Question 9

In coronal imaging, what are the standard views?

Answer 9

1. Frontal horns
2. Foramen of Monro
3. Posterior aspect of third ventricle through thalamus
4. Quadrigeminal cistern
5. Atria of lateral ventricles
6. Parietal and occipital cortex

Question 10

What are the 4 standard views in sagital imaging?

Answer 10

1. Midline
2. Caudothalamic groove
3. Body of each lateral ventricle
4. Each cerebral cortex

Question 11

What kind of imaging is used to visualize the posterior fossa?

Answer 11

mastoid views, obtained through mastoid fontanelle

Question 12

Which premature infants should have head ultrasound?

Answer 12

-

Question 13

When do most germinal matrix hemorrhages occur?

Answer 13

most within 3 days of life, 90% within first week

Question 14

Describe germinal matrix hemorrhage Grade 1

Answer 14

limited to subependymal area (groove)

Question 15

Describe germinal matrix hemorrhage Grade 2

Answer 15

intraventricular extension, but no ventriculomegaly

Question 16

Describe germinal matrix hemorrhage Grade 3

Answer 16

intraventricular extension with ventriculomegaly

Question 17

Describe germinal matrix hemorrhage Grade 4

Answer 17

hemorrhage into brain parenchyma

Question 18

What causes porencephalic cysts?

Answer 18

complication of intraparenchymal hemorrhage, cysts form after resolution of parenchymal hemorrhage

Question 19

What is hydrocephalus?

Answer 19

enlargement of ventricles commonly associated with high grade germinal matrix hemorrhage

Question 20

Ischemic brain injury with necrosis involving the white matter is AKA

Answer 20

Periventricular leukomalacia (PVL)

Question 21

PVL may become _____ in 2-6 weeks

Answer 21

cystic

Question 22

What is HIE?

Answer 22

Hypoxic-ischemic Encephalopathy - usually related to birth asphyxia (gray matter in term babies)

Question 23

TORCH stands for:

Answer 23

• Toxoplasma
• other (Syphilis, HIV)
• Rubella
• Cytomegalovirus
• Herpes

Question 24

When is TORCH infection typically transmitted?

Answer 24

through the placenta, though herpes is often transmitted through birth canal

Question 25

With TORCH infections, look for ______ in the brain

Answer 25

calcifications

Question 26

Sonographic findings of agenesis of corpus callosum

Answer 26

• frontal horns widely separated

- radial arrangement of sulci and gyri “sunburst”

Question 27

Meningomyelocele is almost always associated with

Answer 27

Chiari II malformation

Question 28

Chiari II results in _____ ventricles

Answer 28

dilated and hydrocephalus

Question 29

Dandy Walker complex results in

Answer 29

posterior fossa cystic malformation

Question 30

What is BESS?

Answer 30

benign enlargement of the subarachnoid spaces

Question 31

With BESS, the anterior interhemispheric measurement is

Answer 31

> 5 mm

Question 32

How does one distinguish BESS from subdural bleeds?

Answer 32

vessels coursing through fluid confirm it’s subarachnoid in location

Question 33

If choroid plexus cysts are large or bilateral, what might this indicate?

Answer 33

increased incidence of chromosomal abnormalities