neonatal brain 3 Flashcards
what is hydrocephalus
progressive dilation of ventricular system
3 mechanisms leading to hydro cephalic
Obstruction to CSF outflow
Decreased CSF absorption
CSF overproduction
what grades of hemorrhage can cause hydrocephalus
3 and 4
what are 3 signs of hydrocephalus
Increasing head size
Bulging of the anterior fontanelle
Separation of cranial sutures
what can occur later with hydro cephalic
Bradycardia, apnea and increased ICP
thus monitoring is important
what is ependymitis
swelling of the ependymal linings of the ventricles.
it will have increased echogenicity
infants with progressive hydrocephalus and increased ICP may require
shunt
what is done to identify ICP
a slight pressure is applied to the head with using spectral doppler of pericallosal artery
does cerebellar hemorrhage have crazy symptoms
no it may be silent and just found out of routine
how is cerebral hemorrhage viewed
through mastoid fontanelle
normal posterior fossa viewed through
mastoid fontanelle
what will hemorrhage appear as
large echogenic space
what is periventricular leukomalacia
hypoxic ischemic brain injury
leukomalacia means softening of white tissue
common sites of periventricular leukomalacia
White matter adjacent to peritrigonal area of lateral ventricles
Frontal cerebral white matter anterolateral to frontal horns
sono appearance of PVL
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
long term effects of PVL
cerebral palsy, developmental abnormalities, intellectual and visual impairment
appearance of agenesis of corpus callosum
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
dandy walker malformation has a spectrum of anomalies affecting
posterior fossa
7 anomalies of dandy walker malformations
Cystic dilatation of 4th ventricle Superior elevation of the tentorium Absence of vermis Small cerebellar hemispheres Hydrocephalus agenesis of CC holoprosencephaly
most common type of chiari malformation
chiari 2
what is chiari malformation almost always associated with
myelomenigocele
what is seen when the 3rd ventricle is dilated and what does it connect
massa intermedia
connects two thalami and crosses the third ventricle
several sono appearance of chiari malformation
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
coronal plane sign of chiari 2 malformation
bat wing appearance
most common intracranial vascular anomaly in neonate
vein of galen malformation
what is vein of galen malformation
midline cerebral AV malformation that causes dilatation of v. of Galen
Anterior and posterior cerebral arteries feed the malformation
Decreased blood supply to brain – atrophy and calcifications of brain
what sono signs are seen with vein of galen malformation
cystic structure
turbulent flow
increased systolic and diastolic flow velocities
what is holoprosencephaly
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
most severe holoprosencephaly
most severe
alobar type are stillborn or die shortly after birth
facial defects as a result of alobar holoprosencephaly
Severe facial anomalies Close set eyes – hypotelorism Cyclopia Proboscis – nose on forehead Cleft lip/palate
brain defects as a result of alobar
There is a thin pancake like primitive cerebrum covering a horseshoe shaped midline monoventricle Missing: Corpus callosum Third ventricle Interhemispheric fissures Thalami are fused
semilobar brain defects
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
intracranial infections torch acronym
T Toxoplasmosis O Others R Rubella C Cytomegalovirus CMV H Herpes Simplex
most common intracranial infection
CMV
2nd mots common intracranial infection
toxoplasmosis
intracranial infections transmit how
via placenta
except herpes is transmitted at birth
role of US with intracranial infections
observe Parenchymal calcifications and Lenticulostriate vasculopathy
what is seen sono with CMV
non shadowing echogenic foci representing parenchymal calcifications
what is seen on sonogram with lenticulostriate vasculopathy
Bilateral branching of echogenic foci in the basal ganglia (these are mineral deposits)
