Neonatal Neurology

Question 1

Myelomeningoceles are most commonly associated with which congenital brain anomaly?

Answer 1

Arnold-Chiari malformation type II– herniation of the cerebellar tonsils, fourth ventricle, choroid plexus and/or medulla of the brain stem through the foramen magnum

Question 2

What percent of myelomeningoceles are associated with progressive hydrocephalus requiring surgical repair?

Answer 2

~50-90%

Question 3

Common complication of ETV and treatment?

Answer 3

ETV: Endoscopic third ventriculostomy +/- CPC (choroid plexus cauterization)

Common transient complication: post-operative central diabetes insipidus (injury to the hypothalamus during surgery– resolves within ~10 days).

Treatment: replace water deficit with D5W, give maintenance Na (even with high Na labs), +/- thiazide diuretics

Question 4

High Risk criteria for BRUE?

Answer 4

Greater than 32 weeks GA with CGA <45 weeks
Age <60 weeks
Need for CPR
Current event was a cluster of episodes
History of prior events, family history of siblings with similar occurrences
Concerning physical exam findings or pertinent positive history (recent respiratory illness, history of emesis/lethargy, bulging fontanelle, bruising, etc)