PEDIATRICS Section 2: Brain Flashcards
Extra-axial fluid spaces are considered enlarged if they are greater than ?
> 5 mm
Etiology of BESSI “benign enlargement of the subarachnoid space in infancy.”
The etiology is supposed to be immature villa (that’s why you grow out of it).
What is the most common cause of macrocephaly?
benign enlargement of the subarachnoid space in infancy (BESSI)
Positive Cortical VEin sign
BESSI
Diagnosis?
BESSI
This is a collection of CSF in the subdural space sec to trauma (or idiopathic)
Subdural Hygroma (elderly)
he cortical veins are displaced awav from the inner table - they are often not seen secondary to compression
Negative Cortial Vein sign in Subdural Hygroma
When is BESSI present? and when does it resolve?
Present at 2-3 mos
common in males
Resolves after 2 years with no treatment
BESSI has increased risk of what condition?
Subdural Bleed (spontaneous or minor trauma)
This is the result of an ischemic / hemorrhagic injury, typically from a hypoxic insult during birthing.
Periventricular Leukomalacia ( Hypoxic-lsGhemic Encephalopathy of the Newborn)
Who are at greatest risk of having Periventricular Leukomalacia ( Hypoxic-lsGhemic Encephalopathy of the Newborn)?
Premature (<1500g).
What develops in 50% of Periventricular Leukomalacia ( Hypoxic-lsGhemic Encephalopathy of the Newborn)
Cerebral Palsy
Explain the pathology of Periventricular Leukomalacia ( Hypoxic-lsGhemic Encephalopathy of the Newborn)
the pathology favors the watershed areas (characteristically the white matter dorsal and lateral to the lateral ventricles).
Classic Periventricular Leukomalacia scenario
Premature/LBW
In Periventricular Leukomalacia, the normal white matter should be less bright than what structure?
Choroid plexus
In Periventricular Leukomalacia, this describes as the physiologic brightness of the posterosuperior periventricular white matter, this should be less bright than the choroid
“Blush”
The difference between Flaring and PVL
Grade 1 PVL persists > 7 days.
What are the lateral findings of PVL?
Development of cavitary periventricular cysts.
Difference between Early and Subacute PVL
The most Severe PVL (Grade 4), is more common in?
A. Full term infants
B. Preterms
A. Full term infants
Mechanism of Germinal Matrix Hemorrhage
Mechanism: Fragile vessels + too much pressure/flow = bleeds
Germinal Matrix Hemorrhage only exists in what type of infants?
An important thing to understand is that the germinal matrix is an embryological entity.
So it only exists in premature infants.
As the fetus matures the thing regresses and disappears.
By 32 weeks, germinal matrix is only present at the ___?
By 36 weeks, what happens?\
Gamesmanship: Similar-looking bleed in a full-term infant, say ___?
By 32 weeks, germinal matrix is only present at the caudothalamic groove.
By 36 weeks, you basically can’t have it (if no GM, then no GM hemorrhage).
Take homepoint - No GM Hemorrhage in a full term infant.
Gamesmanship: Similar looking bleed in a fiill term infant say “choroid plexus hemorrhage” (not GMH).
Who should be screened for Germinal Matrix Hemorrhage?
Premature Infants (<32 weeks, < 1500 grams).
Premature Infants with:
Lethargy
Seizures
Decreased Hematocrit
or a history of “he don’t look so good.”
When do you do the head US?
First week of life (remember this is when 90% of them occur).
Diagnosis?
Describe each!
(A) Grade 1: hemorrhage confined to the left germinal matrix (arrows).
(B) Grade 2: right germinal matrix hemorrhage extending into the lateral ventricle (arrows).
(C) Grade 3: left germinal matrix hemorrhage extending into the lateral ventricle with ventriculomegaly (arrows).
(D) Large intraparenchymal hemorrhage (arrows).
Where is the germinal matrix located?
You tell them apart based on their location. Choroid should not extend anterior to the junction of the caudate and the thalamus (the so called caudothalamic groove).
This is the location of the germinal matrix.
Diagnosis?
Grade I GM hemorrhage (Blood in the caudothalamic groove)
What are the Secondary Consequences of hte GMH?
Diagnosis?
Subependymal Cysts
Diagnosis?
Porencephalic cyst
Diagnosis?
Choroid plexus cysts
Diagnosis?
Coarctation of the Ventricles
