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Neonatal Head Pathology Flashcards

0
Q

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

A

downward displacement of cerebral tonsils

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1
Q

What is the Arnold-Chiari malformation?

A

Associated with Spina Bifida

brain stem, cerebellum pulled toward spinal cord

absence of CSP

banana sign

slide 32 for image

Hydrocephalus

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2
Q

what is type 2 of Arnold-Chiari malformation?

A

most common

associated with meningomyelocele

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3
Q

what is type 3 Arnold-Chiari malformation?

A

High cervical encephalomeningocele

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4
Q

what is type 4 of Arnold-Chiari malformation?

A

severe hypoplasia of cerebellum

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6
Q

What are the three types of holoprosencephaly?

A

Lobar

semilobar

alobar

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7
Q

What is lobar holoprosencephaly?

A

lesast severe

fused frontal horns

separate occipital horns

no facial anomalies

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8
Q

What is semilobar holoprosencephaly?

A

single ventricle

possibly separate temporal and occipital horns

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

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9
Q

what is Alobar holoprosencephaly?

A

most severe

single midline crescent ventricle

fused thalami

absent third vent

multiple facial anomalies

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10
Q

Check slides 35-36

A

for images

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11
Q

What is Dandy-Walker malformation?

A

huge 4th ventricle cyst

with or without secondary dilatation of 3rd and lateral ventricles

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12
Q

What is agenesis of the corpus callosum?

A

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

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13
Q

What is hydranencephaly?

A

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

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17
Q

What is frontal bossing?

A

the front of the head is indented

a sign of arnold-Chiari

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18
Q

When does death typically occur in a baby with hydranencephaly?

A

within the first year of life

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19
Q

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?

A

hydranencephaly

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20
Q

What is hydrocephalus?

A

enlargement of ventricular system

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21
Q

Is hydrocephalus congenital or aquired?

A

can be either

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22
Q

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

A

congenital hydrocephalus

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23
Q

What is obstructive hydrocephalus?

A

interference of the circulation of CSF within ventricle system

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24
Q

what is communicating hydrocephalus?

A

CSF pathways in ventricle system

open

causing decreased absorption

25
Q

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

A

aqueductal stenosis

26
Q

How does aqueductal stenosis appear sonographicallY?

A

widening of the lateral and third ventricles

normal sized fourth ventricle

27
Q

how do you treat aqueductal stenosis?

A

shunts in the ventricles

28
Q

In what plane do you measure ventricular dilatation?

A

in sagittal plane (height at body mid thalamus)

axial plane (width at atrium, level of choriod)

29
Q

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

A

Normal 14mm

30
Q

hemorrhage is classified by _______ and ________ and presence of __________

A

extent

location

hydrocephalus

31
Q

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

A

low birthweight <30 week GA (premature birth)

80% within the first 3 days of life

32
Q

What is a subependymal hemorrhage?

A

MOST COMMON

capillary bleeding in germinal matrix

33
Q

where is a subependymal hemorrhage most commonly seen?

A

at thalamic - caudate groove

because its a hypervascular area and the vessels are thin and hemorrhage easily

34
Q

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

A

intraventricular hemorrhage

35
Q

How many grades of hemorrhage are there?

A

4

36
Q

what is a grade I hemorrhage?

A

SEH or IVH without ventricular dilatation

37
Q

What is a grade II hemorrhage

A

SEH or IVH with mild ventricular dilatation

see slide 61- 62 (intraventricular hemorrhage) for picture

38
Q

What is a grade III hemorrhage?

A

SEH or IVH with moderate or large ventricles

has significant hydrocephalus

picture slide 63-64

39
Q

What is a grade IV hemorrhage?

A

SEH or IVH with intraparenchymal hemorrhage

bleeding out into the cerebral hemisphere

see slide 65 - 66 for picture

40
Q

What is periventricular leukomalacia?

A

necrosis of brain tissue

41
Q

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

A

hypoxia (lack of adequate oxygen to the brain)

ischemia (lack of adequate blood to the brain)

42
Q

What is the most common result of periventricular leukomalacia?

A

cerebral palsy

43
Q

A dangling choroid plexus is indicative of what pathology?

A

Hydrocephalus

it is gravity dependent

see slide 54 for picture

44
Q

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

A

the anatomy!!

45
Q

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

A

trisomy 21…Down’s syndrome

46
Q

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

A

echogenic

see slide 60 for picture

47
Q

How does PVL appear?

A

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.

48
Q

How does edema appear in the brain?

A

slide 72-73for picture

no ventricles seen

very echogenic, heterogeneous

49
Q

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

A

Mid cerebral artery MCA

ACA anterior cerebral artery

finish slide 74

50
Q

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

A

top left circle of Willis

should have low resistance flow in vessels of the brain

51
Q

What are the brain infections?

A

TORCH

t= toxoplasmosis/toxoplasma gondii

o= other infections (hep c, HIV, syphilis)

r= rubella

c= cytomegalovirus

h= herpes simplex virus

52
Q

what do TORCH infections do to the baby?

A

serious complications

developmental delay

mental retardation

slide 77 for picture
death

53
Q

What is ECMO?

A

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

54
Q

What are the complications for a baby needing ECMO?

A

causes sudden significant change in blood pressure to the brain

hemorrhage and ischemia are common

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