Neonatal Head Pathology

Question 0

What is the first of four types of Arnold-Chiari malformation?

Answer 0

downward displacement of cerebral tonsils

Question 1

What is the Arnold-Chiari malformation?

Answer 1

Associated with Spina Bifida

brain stem, cerebellum pulled toward spinal cord

absence of CSP

banana sign

slide 32 for image

Hydrocephalus

Question 2

what is type 2 of Arnold-Chiari malformation?

Answer 2

most common

associated with meningomyelocele

Question 3

what is type 3 Arnold-Chiari malformation?

Answer 3

High cervical encephalomeningocele

Question 4

what is type 4 of Arnold-Chiari malformation?

Answer 4

severe hypoplasia of cerebellum

Question 6

What are the three types of holoprosencephaly?

Answer 6

Lobar

semilobar

alobar

Question 7

What is lobar holoprosencephaly?

Answer 7

lesast severe

fused frontal horns

separate occipital horns

no facial anomalies

Question 8

What is semilobar holoprosencephaly?

Answer 8

single ventricle

possibly separate temporal and occipital horns

mild facial anomalies - proboscis- no nose, soft tissue on forehead

Question 9

what is Alobar holoprosencephaly?

Answer 9

most severe

single midline crescent ventricle

fused thalami

absent third vent

multiple facial anomalies

Question 10

Check slides 35-36

Answer 10

for images

Question 11

What is Dandy-Walker malformation?

Answer 11

huge 4th ventricle cyst

with or without secondary dilatation of 3rd and lateral ventricles

Question 12

What is agenesis of the corpus callosum?

Answer 12

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

Question 13

What is hydranencephaly?

Answer 13

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

Question 17

What is frontal bossing?

Answer 17

the front of the head is indented

a sign of arnold-Chiari

Question 18

When does death typically occur in a baby with hydranencephaly?

Answer 18

within the first year of life

Question 19

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?

Answer 19

hydranencephaly

Question 20

What is hydrocephalus?

Answer 20

enlargement of ventricular system

Question 21

Is hydrocephalus congenital or aquired?

Answer 21

can be either

Question 22

What condition has an imbalance between production of CSF and reabsorption?

Answer 22

congenital hydrocephalus

Question 23

What is obstructive hydrocephalus?

Answer 23

interference of the circulation of CSF within ventricle system

Question 24

what is communicating hydrocephalus?

Answer 24

CSF pathways in ventricle system

open

causing decreased absorption

Question 25

When the aquesduct of sylvius is narrowed or obstructed by malformation of aqueduct or extrinsic pressure, what condition do you most likely have?

Answer 25

aqueductal stenosis

Question 26

How does aqueductal stenosis appear sonographicallY?

Answer 26

widening of the lateral and third ventricles

normal sized fourth ventricle

Question 27

how do you treat aqueductal stenosis?

Answer 27

shunts in the ventricles

Question 28

In what plane do you measure ventricular dilatation?

Answer 28

in sagittal plane (height at body mid thalamus) axial plane (width at atrium, level of choriod)

Question 29

What are the measurements for the varying degrees of ventricular dilatation?

Answer 29

Normal 14mm

Question 30

hemorrhage is classified by _______ and ________ and presence of __________

Answer 30

extent location hydrocephalus

Question 31

which three situations make intracranial hemorrhage more common and would indicate a scan being necessary?

Answer 31

low birthweight <30 week GA (premature birth) 80% within the ***first 3 days of life***

Question 32

What is a subependymal hemorrhage?

Answer 32

***MOST COMMON*** capillary bleeding in germinal matrix

Question 33

where is a subependymal hemorrhage most commonly seen?

Answer 33

at thalamic - caudate groove because its a hypervascular area and the vessels are thin and hemorrhage easily

Question 34

When a subependymal hemorrhage pushes through ependyma in the ventricle, what pathology is created?

Answer 34

intraventricular hemorrhage

Question 35

How many grades of hemorrhage are there?

Answer 35

4

Question 36

what is a grade I hemorrhage?

Answer 36

SEH or IVH without ventricular dilatation

Question 37

What is a grade II hemorrhage

Answer 37

SEH or IVH with mild ventricular dilatation see slide 61- 62 (intraventricular hemorrhage) for picture

Question 38

What is a grade III hemorrhage?

Answer 38

SEH or IVH with moderate or large ventricles has significant hydrocephalus picture slide 63-64

Question 39

What is a grade IV hemorrhage?

Answer 39

SEH or IVH with intraparenchymal hemorrhage bleeding out into the cerebral hemisphere see slide 65 - 66 for picture

Question 40

What is periventricular leukomalacia?

Answer 40

necrosis of brain tissue

Question 41

What are the two reasons a baby might have periventricular leukomalacia?

Answer 41

hypoxia (lack of adequate oxygen to the brain) ischemia (lack of adequate blood to the brain)

Question 42

What is the most common result of periventricular leukomalacia?

Answer 42

cerebral palsy

Question 43

A dangling choroid plexus is indicative of what pathology?

Answer 43

Hydrocephalus it is gravity dependent see slide 54 for picture

Question 44

the brain can have cysts. what must you know in order to determine the difference between cysts and ventricles?

Answer 44

the anatomy!!

Question 45

If you have a unilateral persistent cyst past 21 weeks in utero, what pathology might the baby have?

Answer 45

trisomy 21...Down's syndrome

Question 46

How does a hemorrhage appear in the brain, echogenic or hypoechoic?

Answer 46

echogenic see slide 60 for picture

Question 47

How does PVL appear?

Answer 47

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.

Question 48

How does edema appear in the brain?

Answer 48

slide 72-73for picture no ventricles seen very echogenic, heterogeneous

Question 49

If you see hypoxic/ischemic encephalopathy...doppler. What are the values?

Answer 49

Mid cerebral artery MCA ACA anterior cerebral artery finish slide 74

Question 50

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

Answer 50

top left circle of Willis should have low resistance flow in vessels of the brain

Question 51

What are the brain infections?

Answer 51

TORCH t= toxoplasmosis/toxoplasma gondii o= other infections (hep c, HIV, syphilis) r= rubella c= cytomegalovirus h= herpes simplex virus

Question 52

what do TORCH infections do to the baby?

Answer 52

serious complications developmental delay mental retardation slide 77 for picture death

Question 53

What is ECMO?

Answer 53

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

Question 54

What are the complications for a baby needing ECMO?

Answer 54

causes sudden significant change in blood pressure to the brain hemorrhage and ischemia are common