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Ob/Gyne > Module 11 : Fetal Neural Tube Pathology > Flashcards

Module 11 : Fetal Neural Tube Pathology Flashcards

1
Q

What produces CSF

A

Choroid plexus

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2
Q

Where are the choroid plexus located

A
  • body of lat ventricle
  • roof of third vent
  • superior lateral walls of fourth vent
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3
Q

Flow of CSF through the brain

A

Choroid plexus&raquo_space; lat vents&raquo_space; interventricular foramen&raquo_space; 3rd vent&raquo_space; cerebral aqueduct&raquo_space; fourth vent&raquo_space; megendie ( spinal cord) and Lushka ( brain)

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4
Q

Normal fourth vent location

A
  • anterior and inferior edge of cerebellum
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5
Q

Hydrocephalus

A
  • increase in CSF that results in enlargement of ventricular system
  • usually due to obstruction along the pathway to CSF
  • MOST COMMON CRANIAL ANOMALY
  • dangling choroid
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6
Q

Intraventricular obstruction hydrocephalus - aqueduct stenosis

A
  • csf can’t flow from 3rd vent to 4th vent

- lat and 3rd bent enlarged but 4th vent normal

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7
Q

Extraventricular obstruction hydrocephalus - spine bifida

A
  • CSF can’t flow normally through the spinal canal and back up in ventricle of brain
  • ALL ventricles effects s
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8
Q

Extraventricukar obstruction hydrocephalus - excess CSF

A
  • less common

- excess secretion from a choroid plexus papilloma (tumor)

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9
Q

Types of extraventricular obstruction hydrocephalus

A
  • spina bifida
  • excess CSF
  • dandy walker malformation
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10
Q

Evaluating ventricular size

A 
- measure ATRIAL diameter
  \+ size doesn’t change much 15 - 35
   \+ normal size 7mm
   \+ 10 mm upper limit of normal
- < 3mm from medial vent wall to choroid
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11
Q

Dangling choroid

A
  • always rests in a gravitationally dependent position

- sign of hydrocephalus

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12
Q

True hydrocephalus

A
  • either from CSF obstruction OR ventriculomegaly resulting from brain atrophy
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13
Q

Causes of true hydrocephalus

A
  • neural tube defect NTD
  • aqueductal stenosis
  • dandy walker malformation
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14
Q

Ventriculomegalyt

A
  • brain atrophy result in a smaller brain allowing ventricles more room to expand
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15
Q

Where to look when hydrocephalus is suspected

A
  • additional anomalies tend to occur with hydrocephalus
  • posterior fossa views
    + cisterna magna and cerebellum
    = obliterated cisterna magna
    = deformed cerebellum (banana)
    = lemon sign
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16
Q

Banana sign

A
  • indicates obliterated cisterna magna
  • ## often ARNOLD CHIARI
17
Q

Lemon sign

A
  • resulting when cranial contents are pulled toward spine with Arnold Chiari II malformation
    + associated with spina bifida
  • frontal bones caved in
  • seen in second trimester
  • lemon sign disappears in 3rd trimester due to resulting in hydrocephalus from enlarging ventricles of blocked CSF
18
Q

Dandy walker malformation DWM

A
  • enlarged cisterna magna and defect in the cerebellar VERMIS
  • the cisterna magna communicates with the 4th vent through a defect in cerebellum
  • ventricles can be enlarged due to pressure in the post fossa
19
Q

Dandy walker variant

A
  • partial agenisis of the vermis with a smaller cisterna magna and minimal dilation of the ventricles
  • associated with many syndromes
20
Q

DWM associated with

A
  • intellectual impairment and fetal steam
  • AGENISIS OF CORPUS CALLOSUM
  • heart defects
  • genitourinary
  • polydactyly
  • increase risk
    + maternal viral infection
    + alcohol consumption
    + maternal diabetes
21
Q

Assessing DWM

A
  • cisterna magna > 1cm abnormal
  • cerebellar view must include
    + caveman septi pellucidi
    + peduncles
    + cerebellum
  • measure
22
Q

What to prove for DWM

A
  • cisterna magna communicates with 4th vent
  • cerebbellaR VERMIS absent or partially absent
  • enlarged ventricles
  • DDx = arachnoid cyst in posterior fossa
23
Q

Arachnoid cysts in post fossa

A
  • fluid collections in the layers of teh arachnoid membrane

- cysts can occur anywhere in the brain

24
Q

Choroid plexus cysts CPC

A
  • cysts in choroid plexus
  • usually disappear in 2nd trimester
  • associated with trisomy 18
    + 1 / 200 are associate with T18
  • HAVE TO BE > 3MM
25
Q

Nuchal fold

A
  • 80% of infants with T21 have redundant skin in the posterior part of the neck
  • can only be assessed between 16 and 20 weeks because of gestational diabetes
26
Q

Gestational diabetes mellitus

A
  • mothers with GDM the fetus can be LGA
  • baby will have more fat in general making nuchal fold thick
  • occurs after 20 weeks
  • continuing to measure nuchal fold with make lots of false positives
27
Q

Assessing nuchal fold

A
  • greater than or equal to 6 mm abnormal

- measure from outer skull to outer skin surface

28
Q

Acrania

A
  • absent skull / cal aria
29
Q

Anencephaly

A
  • no or distorted cerebral cortex
30
Q

Exenceohaly

A
  • some cerebral cortex but abnormal
  • early stage of anencephaly
  • brain tissue exposed to amniotic fluid gets damages
  • brain tissue in beginning (excencephaly) then by time fetus is imaged there is minimal tissue left so diagnosed anencephaly
31
Q

Sonographic features of anencephaly

A
  • facial structures present and orbits
  • no calvaria (skull) above orbits
  • image through face would resemble a frog
  • polyhydroamnios (no swallowing)
  • very active fetus
  • can not be reliable diagnoses before 12-13 weeks

Ob/Gyne (24 decks)

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