Neonatal Head Flashcards
what are the 3 sutures called
coronal
sagittal
lambdoid
what are the 2 fontanelle’s called
anterior (most commonly used for scanning) - soft spot
posterior
what does the foramen of Monro connect
lateral ventricles to the 3rd ventricle
what does the aqueduct of Sylvius connect
3rd ventricle to 4th ventricle
what are the 3 regions of the brain
forebrain
midbrain
hindbrain
what is the forebrain
Prosencephalon
mature
thalamus, epithalamus, hypothal, subthal, cerebral hemispheres, and olfactory system (senses)
what is the midbrain
Mesencephalon
mature
midbrain
what is hindbrain
example slide 6-7
Rhombencephalon
medulla
pons & cerebellum
what transducer would you use to scan a neonatal head
7-10 mhz linear
highest frequency with the smallest face
what is most important about scanning a neonatal head and following a protocol
it is important to follow the same protocol as the previous studies so that the doctor can compare them more easily
1st image TRV/coronal consists of what
anterior brain - show falx
2nd image TRV/coronal consists of what
anterior horns of lateral ventricles
contains anterior horn, caudate nucleus, corpus callosum, CSP
3rd image TRV/coronal consists of what
mid ventricles
contains sylvain fissure, MCA, foramen of monro connects to 3rd vent, 3rd vent, CSP, corpus callosum
4th image TRV/coronal consists of what
mid lateral ventricle
contains choroid plexus, lat vents, tail of caudate nucleus, corpus callosum, falx
5th image TRV/coronal consists of what
body of ventricles
choroid plexus in atria of lateral ventricles
occiput
6th image TRV/coronal consists of what
posterior brain
contains lat vents, falx, tentorium cerebelli
how do you image the neonates head coronally/TRV
place at the soft spot (fontanelle) and then sweep anterior to posterior without moving the transducer from the soft spot
how do you image the neonates head sagitally/LONG
place at the soft spot (fontanelle) and then sweep left to right without moving the transducer from the soft spot
medial, lateral x 3 left, medial, lateral x 3 right
1st sagittal image consists of what - medial
3rd vent aquaduct of sylvius corpus callosum 4th vent cisterna magnum cerebellum
2nd sagittal image consists of what - lateral left or right
lat vents
choroid plexus
3rd sagittal image consists of what - lateral left or right
lat vents thalamus caudate nucleus caudate thalamus groove show posterior horn
4th sagittal image consists of what - lateral left or right
lateral to ventricle
parietal lobe
temporal lobe
describe arnold-chiari malformation
associated with spina bifida
brain stem, cerebellum pulled toward spinal cord, absence of CSP
hydrocephalus
**“banana peel” sign of cerebellem
**frontal bossing - forehead comes to a point
what are the 4 types of arnold-chiari malformation
type 1. downward displacement of cerebral tonsils
**type 2. MOST COMMON - associated with meningomyelocele
type 3. high cervical encephalomeningocele
type 4. severe hypoplasia of cerebellum
what are the 3 types of holoprosencephaly
lobar
semilobar
alobar
describe lobar holoprosencephaly
LEAST SEVERE
fused frontal horns
separate occipital horns
no facial anomaly
describe semilobar holoprosencephaly
single ventricle
can separate temporal & occipital horns
mild facial anomaly
describe alobar holoprosencephaly
MOST SEVERE
single midline cresent ventricle
fused thalami
absent 3rd vent
multiple facial anomalies - one eye, one nostril, nose off forehead, etc
describe dandy-walker malformation
huge 4th ventricle cyst
with or without secondary dilatation of 3rd and lateral vents
found in the posterior fossa
describe agenesis of the corpus callosum
absence of the corpus callosum (to any degree)
narrow frontal horns
marked separation of anterior horns and lateral vents
dilated occipital horns and 3rd vent.
“vampire wings” or “bat wings”
what is hydranencephaly
brain cerebral hemispheres are absent and replaced by sacs filled with cerebrospinal fluid
extreme form of porencephaly which is characterized by a cyst or cavity in the cerebral hemispheres
what is the progression of hydranencephaly
initally normally but after a few weeks irritable and increased muscle tone (hypertonia)
after several months, seizures & hydrocephalus - visual impairment, lack of growth, deafness, blindness, paralysis
prognosis is generally quite poor - death usually within the 1st yr
what is hydrocephalus
enlargement of ventricular system - congenital or acquired
what is congenital hydrocephalus
imbalance between production of CSP and reabsorption
present at birth
2 types are obstructive and comunicating
what is obstructive hydrocephalus
interference of the circulation of CSF within vent system
what is communicating hydrocephalus
CSF pathways in vent system open
decreased absorption
what is aqueductal stenosis - Aqueduct of Sylvius
narrowed or obstructed by malformation of aqueduct or extrinsic pressure
sono - widening of the lateral and 3rd vent, normal sized 4th vent
treatment - shunts
what is ventricular dilatation
know measurements
measured in sagittal plane (height at body mid thalamus) and axial plane (width at atrium, level of choroid)
mild = 8-10 mm moderate = 11-14 mm large = > 14 mm
describe hemorrhage
classified by extent and location of hemorrhage and presence of hydrocephalus
intracranial hemorrhage more common with low birth weight, premature birth, 80% within first 3 days of life
what is the MOST COMMON intraventricular hemorrhage
Subependymal hemorrhage pushes through ependyma into ventricle to form the hemorrhage
capillary bleeding in germinal matrix - most commonly seen at thalamic-caudate groove
how many grades of hemorrhage are there
4
what is hemorrhage grade I
SEH or IVH without ventricular dilatation
what is hemorrhage grade II
SEH or IVH with mild ventricular dilatation
what is hemorrhage grade III
SEH or IVH with moderate or large ventricles
what is hemorrhage grade IV
SEH or IVH with intraparenchymal hemorrhage
what is periventricular leukomalacia
necrosis of the brain tissue
deals with hypoxia and ischemia
cerebal palsy is a common result
define hypoxia
lack of adequate oxygen to the brain
define ischemia
lack of adequate blood to brain
what is a definitive sign of hydrocephalus
gravity dependent
the choroid is going to dangle
describe hypoxia/ischemic encephalopathy doppler
DOPPLER OF MCA OR ACA:
normal RI .65-.90
RI of .90 is indicative of immediate & long term poor outcome
doppler is not routine, must be ordered by physician
ACA obtained from anterior fontanelle, MCA obtained from temporal fontanelle
what is a sign of down syndrome in utero
unilateral cyst that persists after 21 wks
describe brain infections
serious complication - developmental delay, mental retardation, death
caused congenitally by TORCH infections
what are TORCH infections
T - toxoplasmosis/toxoplasma gondii O - other infections (hep c, hiv, syphilis, etc) R - rubella C - cytomegalovirus H - herpes simplex virus
what does ECMO stand for
extracorporeal membrane oxygentation
what is ECMO
support infants with underdeveloped or abn lungs, meconium aspiration, or congenital heart disease
causes sudden significant change in bp to brain
hemorrhage and ischemia are common
insert cannula into rt jugular vein and carotid
