Neonatal Head Pathology Flashcards
What is the first of four types of Arnold-Chiari malformation?
downward displacement of cerebral tonsils
What is the Arnold-Chiari malformation?
Associated with Spina Bifida
brain stem, cerebellum pulled toward spinal cord
absence of CSP
banana sign
slide 32 for image
Hydrocephalus
what is type 2 of Arnold-Chiari malformation?
most common
associated with meningomyelocele
what is type 3 Arnold-Chiari malformation?
High cervical encephalomeningocele
what is type 4 of Arnold-Chiari malformation?
severe hypoplasia of cerebellum
What are the three types of holoprosencephaly?
Lobar
semilobar
alobar
What is lobar holoprosencephaly?
lesast severe
fused frontal horns
separate occipital horns
no facial anomalies
What is semilobar holoprosencephaly?
single ventricle
possibly separate temporal and occipital horns
mild facial anomalies - proboscis- no nose, soft tissue on forehead
what is Alobar holoprosencephaly?
most severe
single midline crescent ventricle
fused thalami
absent third vent
multiple facial anomalies
Check slides 35-36
for images
What is Dandy-Walker malformation?
huge 4th ventricle cyst
with or without secondary dilatation of 3rd and lateral ventricles
What is agenesis of the corpus callosum?
absence of the corpus callosum (to any degree)
narrow frontal horns
marked separation of anterior horn and lateral vents
dilated occipital horns and third ventricle
bat (vampire) 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 frontal bossing?
the front of the head is indented
a sign of arnold-Chiari
When does death typically occur in a baby with hydranencephaly?
within the first year of life
A baby that starts out normal but then starts to become irritable, increased muscle tone, seizures, hydrocephalus, visual impairment, lack of growth, deafness, blindness, spastic paralysis and intellectual deficits, may have what disease?
hydranencephaly
What is hydrocephalus?
enlargement of ventricular system
Is hydrocephalus congenital or aquired?
can be either
What condition has an imbalance between production of CSF and reabsorption?
congenital hydrocephalus
What is obstructive hydrocephalus?
interference of the circulation of CSF within ventricle system
what is communicating hydrocephalus?
CSF pathways in ventricle system
open
causing decreased absorption
When the aquesduct of sylvius is narrowed or obstructed by malformation of aqueduct or extrinsic pressure, what condition do you most likely have?
aqueductal stenosis
How does aqueductal stenosis appear sonographicallY?
widening of the lateral and third ventricles
normal sized fourth ventricle
how do you treat aqueductal stenosis?
shunts in the ventricles
In what plane do you measure ventricular dilatation?
in sagittal plane (height at body mid thalamus)
axial plane (width at atrium, level of choriod)
What are the measurements for the varying degrees of ventricular dilatation?
Normal 14mm
hemorrhage is classified by _______ and ________ and presence of __________
extent
location
hydrocephalus
which three situations make intracranial hemorrhage more common and would indicate a scan being necessary?
low birthweight <30 week GA (premature birth)
80% within the first 3 days of life
What is a subependymal hemorrhage?
MOST COMMON
capillary bleeding in germinal matrix
where is a subependymal hemorrhage most commonly seen?
at thalamic - caudate groove
because its a hypervascular area and the vessels are thin and hemorrhage easily
When a subependymal hemorrhage pushes through ependyma in the ventricle, what pathology is created?
intraventricular hemorrhage
How many grades of hemorrhage are there?
4
what is a grade I hemorrhage?
SEH or IVH without ventricular dilatation
What is a grade II hemorrhage
SEH or IVH with mild ventricular dilatation
see slide 61- 62 (intraventricular hemorrhage) for picture
What is a grade III hemorrhage?
SEH or IVH with moderate or large ventricles
has significant hydrocephalus
picture slide 63-64
What is a grade IV hemorrhage?
SEH or IVH with intraparenchymal hemorrhage
bleeding out into the cerebral hemisphere
see slide 65 - 66 for picture
What is periventricular leukomalacia?
necrosis of brain tissue
What are the two reasons a baby might have periventricular leukomalacia?
hypoxia (lack of adequate oxygen to the brain)
ischemia (lack of adequate blood to the brain)
What is the most common result of periventricular leukomalacia?
cerebral palsy
A dangling choroid plexus is indicative of what pathology?
Hydrocephalus
it is gravity dependent
see slide 54 for picture
the brain can have cysts. what must you know in order to determine the difference between cysts and ventricles?
the anatomy!!
If you have a unilateral persistent cyst past 21 weeks in utero, what pathology might the baby have?
trisomy 21…Down’s syndrome
How does a hemorrhage appear in the brain, echogenic or hypoechoic?
echogenic
see slide 60 for picture
How does PVL appear?
slide 69 for pic
echogenic area around the ventricles
see how it develops by day on slide 70 (becomes more echogenic until tissue is dead and then starts to have cystic areas. severe cases will look like Swiss cheese) slide 71
can happen in full term babies…for any reason blood or O2 is cut off from baby.
How does edema appear in the brain?
slide 72-73for picture
no ventricles seen
very echogenic, heterogeneous
If you see hypoxic/ischemic encephalopathy…doppler. What are the values?
Mid cerebral artery MCA
ACA anterior cerebral artery
finish slide 74
What is the main blood vessel area of the brain that we are concerned with called? What kind of flow should it have?
see Slide 75 for picture
top left circle of Willis
should have low resistance flow in vessels of the brain
What are the brain infections?
TORCH
t= toxoplasmosis/toxoplasma gondii
o= other infections (hep c, HIV, syphilis)
r= rubella
c= cytomegalovirus
h= herpes simplex virus
what do TORCH infections do to the baby?
serious complications
developmental delay
mental retardation
slide 77 for picture
death
What is ECMO?
extracorporeal membrane oxygenation
support infants with underdeveloped or abnormal lungs, meconium aspiration or congenital heart disease
basically oxygenates the blood and puts it back into the baby
What are the complications for a baby needing ECMO?
causes sudden significant change in blood pressure to the brain
hemorrhage and ischemia are common
