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OB/GYN REVIEW > 2nd & 3rd Tri: Central Nervous System > Flashcards

2nd & 3rd Tri: Central Nervous System Flashcards

1
Q

When is the neural tube closed by?

A

6 menstrual weeks

pg. E 120

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2
Q

What plane is best to evaluate for spina bifida?

A

transverse

pg E 120

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3
Q

What should be shown in the trransverse plane of the spine?

A

location of ossification centers
musculature of back
skin line

pg. E 120

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4
Q

What should be shown in the sagittal/coronal plane of the spine?

A

cervical and lumbosacral curvatures
sacral tapering
configuration of vertebral ossification centers
pg. E 120

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5
Q

At what level is the BPD taken?

A

level of thalami, CSP, and anterior horns of lat ventricle

pg. E 121

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6
Q

What is a normal measurement for the atrium of lateral ventricle?

A

< 10 mm

pg. E 121

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7
Q

What fills in the lateral ventricles?

A

choroid plexus

pg. E 122

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8
Q

What is taken at an axial section of the brain?

A 
CSP
thalami
lateral ventricles
choriod plexus
BPD
HC
pg. E 121
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9
Q

What is taken at an oblique axial section of the brain?

A

cerebellum
brain stem
cisterna magna
pg. E 123

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10
Q

What is a normal measurement of the cisterna magna?

A

> 3 mm and < 10 mm

pg. E 123

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11
Q

Why do neural tube defects occur?

A

when neural tube fails to close by 6 weeks

pg. E 124

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12
Q

Where do neural tube defects occur at?

A

anywhere along cranium or spine
allow cerebrospinal fluid to escape into the amniotic fluid
pg. E 124

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13
Q

What lab is elevated with neural tube defects?

A

MSAFP

pg. E 124

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14
Q

Why would an amniocentesis be performed?

A

when MSAFP values are high and ultrasound did not detect a neural tube defect
pg. E 124

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15
Q

What does an amniocentesis detect?

A

acetylcholinesterase is elevated in the amniotic fluid when there are neural tube defects
pg. E 124

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16
Q

What can be done to decrease the risk of neural tube defects?

A

supplement folic acid

pg. E 124

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17
Q

What is anencephaly?

A

congenital absence of the cerebral hemispheres and cranial vault
pg. E 124 O 390

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18
Q

What is the most common neural tube defect?

A

Anencephaly

pg. O 390

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19
Q

Why does anencephaly occur?

A

cephalic end of the neural tube fails to close by 24 days gestation
pg. E 124 O 390

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20
Q

What is elevated with anencephaly?

A

AFP

pg. E 124 O 390

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21
Q

What is associated with anencephaly?

A

polyhydramnios
spina bifida
pg. E 124

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22
Q

What are the sonographic findings of anencephaly?

A

absent cranial vault and cerebral hemispheres
frog-like facial appearance
polyhydramnios
pg. E 124

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23
Q

What is acrania?

A

cranium partially or completely absent with development of abnormal brain tissue
pg. E 125

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24
Q

What is elevated with acrania?

A

MSAFP

pg. E 125

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25
Q

What are the sonographic findings of acrania?

A

presence of brain tissue as early as 12 weeks -16 weeks
lack of ossified cranium
pg. E 125

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26
Q

What is exencephaly?

A

acrania

pg. E 125

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27
Q

What is an encephalocele?

A

herniation of brain and meninges or meninges and CSF through a cranial defect
pg. E 125 O 390

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28
Q

What syndrome is an encephalocele associated with?

A

Meckel-Gruber syndrome

pg. E 125

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29
Q

Where are encephaloceles located?

A

midline
occipital (most common)
frontal or lateral
pg. E 125

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30
Q

What are the sonographic findings of encephalocele?

A 
cystic extracranial mass (meningocele)
solid mass in cranium (cephalocele)
hydrocephalus
polyhydramnios
pg. E 125
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31
Q

What is another name for encephalocele?

A

cephalocele

pg. E 125

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32
Q

What is spina bifida?

A

lack of closure of the vertebral column

pg. E 126 O 390

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33
Q

Where is the most common place for spina bifida?

A

lumbosacral

pg. E 126

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34
Q

What is a meningocele?

A

herniation of the meningese and CSF through a spinal defect

pg. E 126

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35
Q

What is meningomyelocele?

A

herniation of the meninges and spinal cord through the spinal defect
pg. E 126

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36
Q

What are the transverse findings of spina bifida?

A

splaying of posterior elements into a U or V configuration
cystic structure extending from back
pg. E 126

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37
Q

What are the sagittal findings of spina bifida?

A

splaying of parallel ossification centers
soft tissue defect
pg. E 126

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38
Q

What are some intracranial findings associated with spina bifida?

A

“lemon sign” - head shape
“banana sign” - cerebellum shape
hydrocephalus
pg. E 127

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39
Q

What is associated with spina bifida?

A

Arnold-Chiari II malformation

pg. E 127

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40
Q

What is spina bifida aperta?

A

defect exposed completely
elevated AFP level
associated w/ cleft lip, cardiac defects, encephalocele, GI anomalies, and clubfoot
pg. O 390

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41
Q

What is spina bifida occulta?

A

defect is covered by soft tissue
normal AFP level
not as easily diagnosed w/ US
pg. O 390

42
Q

What is iniencephaly?

A

rare malformation where the occiput is fused to the cervical spine
pg. E 127

43
Q

What are the sonographic findings of iniencephaly?

A

hyperextended neck and head
occipital encephalocele/cervical spina bifida
pg. E 127

44
Q

How does cerebrospinal fluid flow through the ventricles?

A

lateral ventricles –>3rd ventricle –> 4th ventricle

pg. E 128

45
Q

What is ventriculomegaly?

A

dilatation of the ventricular system due to increase in volume of CSF
pg. E 128

46
Q

When is ventriculomegaly considered hydrocephalus?

A

head enlarges and CSF spreads
can cause brain damage
pg. E 128

47
Q

What is obstructive hydrocephalus?

A

aka non-communicating;
obstruction of CSF flow due to aqueductal stenosis, CNS anomaly, or tumor
E 129

48
Q

What is aqueductal stenosis?

A

narrowing of the aqueduct of Sylvius due to inflammation or developmental process
pg. E 129

49
Q

What is communicating hydrocephalus?

A

dilatation of all ventricles and subarachnoid space caused by an obstruction to CSF flow outside of the ventricular system
pg. E 129

50
Q

What are the sonographic findings of hydrocephalus?

A

dilated ventricles > 10mm
dangling choroid plexus
brain echogenicity
pg. E 129

51
Q

What are some other associated findings with hydrocephaly?

A 
polyhydramnios
abnormal fetal lie
fetal ascites
hepatomegaly
meningomyelocele
Dandy Walker Malformation
encephalocele
intracranial tumor
pg. E 129
52
Q

What is holoprosencephaly?

A

absent or incomplete division of the forebrain (prosencephalon) into the cerebral hemispheres and lateral ventricles
pg. E 130

53
Q

What are the types of holoprosencephaly?

A

alobar
semi-lobar
lobar
pg. E 130

54
Q

What is the most severe form of holoprosencephaly?

A

Alobar

pg. E 130

55
Q

What are the sonographic findings of alobar holoprosencephaly?

A

1 ventricle
fused thalami
absence of falx cerebri
pg. E 130

56
Q

What are the sonographic findings of semi-lobar holoprosencephaly?

A

partial separation of the ventricles and hemispheres
occipital lobe present
incompletely fused thalami
pg. E 130

57
Q

What are the sonographic findings of lobar holoprosencephaly?

A

least severe
normal separation of the thalami, hemispheres, and ventricles
absent CSP and olfactory tracts
pg. E 130

58
Q

What reasons can holoprosencephaly be caused by?

A

Sporadic - chromosomal abnormalities
maternal infection
pg. E 130

59
Q

What are some associated findings with holoprosencephaly?

A

facial anomalies- cyclopia w/ proboscis
hypotelorism
facial clefts
pg. E 130

60
Q

What is hydranencephaly caused by?

A

ICA occlusion or malformation

pg. E 131

61
Q

What is hydranencephaly?

A

near total lack of cerebral hemispheres with normally developed meninges and skull
brain is replaced w/ CSF
pg. E 131 O 389

62
Q

What anomalies are associated with hydranencephaly?

A

no associated anomalies or risk

pg. E 131

63
Q

What are the sonographic findings of hydranencephaly?

A 
macrocephaly
fluid filled cranium
absent cerebral tissue
necrosis
polyhydramnios
pg. E 131
64
Q

What is Dandy-Walker Malformation (DWM)?

A

complete or partial absence of cerebellar vermis and posterior fossa cystic dilatation
pg. E 131 O 389

65
Q

What can cause DWM?

A 
autosomal recessive syndromes
maternal infection
diabetes
alcohol use
Coumadin use
pg. E 131 O 389
66
Q

What are the sonographic findings of DWM?

A 
enlarged posterior fossa
complete or partial agenesis of the cerebellar vermis
cisterna magna > 1.0 cm
ventriculomegaly
polyhydramnios
pg. E 131 O 389
67
Q

What do 80% of DWM fetuses have?

A

hydrocephalus

pg. E 131

68
Q

When should the corpus callosum be developed by?

A

20 weeks

pg. E 132

69
Q

Why does the corpus callosum not develop?

A

chromosomal abnormality or translocation
failure of callosal fibers to form
pg. E 132

70
Q

What are the sonographic findings of agenesis of the corpus callosum?

A 
no CSP
dilatation of the 3rd ventricle
widely separated frontal horns of lateral ventricles with enlarged occipital horn
teardrop shaped ventricles 
Colpocephaly
"Sunburst sign"
pg. E 132 O 388
71
Q

What is a vein of Galen aneurysm?

A

rare arteriovenous malformation causing increased flow through the vein of Galen.
pg. E 132

72
Q

What are the songoraphic findings of a vein of Galen aneurysm?

A

midline vascular structure superior and posterior to thalamus with turbulent arterial flow
pg. E 132

73
Q

What is a choroid plexus cyst?

A 
unilateral or bilateral
single or multiple
large or small
cysts in ventricle
pg. E 133
74
Q

Are choroid plexus cysts common?

A

yes

pg. E 133

75
Q

Are choroid plexus cysts associated with other anomalies?

A

normally isolated finding, but can be associated with aneuploidy (Trisomy 18 specifically)
pg. E 133

76
Q

What would be the most common intracranial lesion?

A

teratomas

pg. E 133

77
Q

What is lissencephaly?

A

brain lacks sulci and gyri, which make the brain appear smooth
pg. E 133

78
Q

What is lissencephaly associated with?

A

ventriculomegaly
abnormal corpus callosum
pg. E 133

79
Q

When can lissencephaly be diagnosed?

A

3rd trimester

pg. E 133

80
Q

What is schizencephaly?

A

rare malformation with clefts in the cerebral hemispheres

pg. E 134

81
Q

What is the sonographic appearance of schizencephaly?

A

typically bilateral and symmetric
brain appears split into anterior/posterior parts
pg. E 134

82
Q

What is porencephaly?

A

presence of cysts within the cerebral parenchyma due to intracranial hemorrhage
pg. E 134

83
Q

What is the sonographic appearance of porencephaly?

A

simple cystic structures within cerebral parenchyma

pg. E 134

84
Q

What is microcephaly?

A 
decreased head size (3 SD below mean)
due to several etiologic disturbances: 
chromosomal
craniosynostosis
teratogens
pg. E 134
85
Q

What is a sacrococcygeal teratoma?

A

rare tumor arising from the embryonic cells of the sacrum/coccyx
pg. E 135

86
Q

What are the sonographic findings of sacrococcygeal teratomas?

A 
large complex mass
external or internal 
polyhydramnios
hydrops fetalis
increased AFP
pg. E 135
87
Q

What is caudal regression syndrome?

A

spectrum of skeletal anomalies of the caudal end of the neural tube
pg. E 135 O 390

88
Q

What is caudal regression syndrome associated with?

A

diabetes mellitus
sporadic
pg. E 135 O 390

89
Q

What anomalies are associated with caudal regression syndrome?

A 
sacral, lumbar or thoracic agenesis
GI tract
GU tract
CNS
heart
pg. E 135
90
Q

What is scoliosis?

A

abnormal curvature of spine

pg. E 135

91
Q

What are the possibilities if the skull is not present?

A

anencephaly
acrania (exencephaly)
pg. E 136

92
Q

What are the possibilities if the skull is not intact?

A

encephalocele
Meckel-Gruber
pg. E 136

93
Q

What are the possibities if there is no falx cerebri present?

A

holoprosencephaly

pg. E 136

94
Q

What are the possibilities if the thalami are not separate?

A

holoprosencephaly

pg. E 136

95
Q

What are the possibilities if the lateral ventricles measure > 10 mm?

A 
ventriculomegaly
hydrocephalus
Spina bifida
DWM
pg. E 136
96
Q

What are the possibilities if the choroid plexus is not identified or normal?

A

hydranencephaly
choroid plexus cyst
Trisomy 18
pg. E 136

97
Q

What settings should you use to evaluate for a vein of Galen aneurysm?

A

color Doppler

pg. E 136

98
Q

If a fetus is positioned face up, what could you do to optimize visualization of the spine?

A

Lower frequency to increase the penetration

URR exam

99
Q

At what age should a normal cranium be identified?

A

15 weeks

100
Q

When is a head considered macrocephaly?

A

BPD and HC are 2+ SD above average

101
Q

What might an asymmetric encephalocele raise suspicion for?

A

Limb-body wall complex

OB/GYN REVIEW (16 decks)

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