Brain pt 2

Question 1

what defines a premature baby?

Answer 1

a baby born brfore 37 weeks GA

Question 2

what is seen in a sagittal midling scan of an immature brain?

Answer 2

The midline cystic cavum septum pellucidum (CS) and cavum vergae (CV) are prominent in the premature infant

Question 3

what is cavum vergae?

Answer 3

• extension of CSP
• persistence of embryological fluid- filled space between the leaflets of the septum pellucidum and is a common anatomical varient

Question 4

where is cavum vergae located?

Answer 4

0 on coronal view located between bodies of lateral ventricles

Question 5

when does closure of the cavum vergae start?

Answer 5

6 month gestation

Question 6

Superior to the cavum is the?

Answer 6

• hypoechoic corpus callosum

- 3rd and 4th ventrivles, with 4th ventricle seen as a triangular lucency indenting the vermis

Question 7

what is visible anterior to the vermis?

Answer 7

the cisterna magna

Question 8

what is seen anterior to the 4th ventricle?

Answer 8

midbrain

Question 9

what is the posterior approach?

Answer 9

• sagittal imaging plane through the posterior frontanelle

- coronal plane is obtained by rotating the transducer 90 degrees

Question 10

Ventricular asymmetry. Coronal scan shows the left lateral ventricle larger than the right. Is this normal?

Answer 10

yes this is a normal varient

Question 11

Intracranial Pathologies? (9)

Answer 11

Intracranial Hemorrhage  - ICH
Hydrocephalus
Cerebellar Hemorrhage
Periventricular Leukomalacia – PVL
Agenesis of Corpus Callosum
Dandy-Walker complex
Chiari Malformation
Holoprosencephaly
Intracranial Infections

Question 12

what is an Intracranial hemorrhage?

Answer 12

• one of the main indications for u/s and a major cause of morbidity and mortality in premature infant

Question 13

what is a Germinal Matrix Intraventricular Hemorrhage (GM-IVH) ?

Answer 13

• Majority occur within 3 days of life in premature infants

Question 14

what is a germinal matrix?

Answer 14

• fetal structure
• fine network of blood vessels and primitive neural tissue
• located in subepindymal region of lateral ventricles

Question 15

where us the most prominent portion of germinal matrix?

Answer 15

• lies in caudothalamic groove

- between caudate nucleus and thalamus

Question 16

Germinal matrix structure?

Answer 16

• has immature fragile blood vessels with poor supporting connective tissues
• highly susceptible to pressure and metabolic changes, which lead to rupture of vessels

Question 17

when does Germinal matrix reach its greatest size?

Answer 17

• at 23-24 weeks
• then it starts to regress
• completely incolutes by 36 weeks

Question 18

Germinal matrix is rare in term babies T or F?

Answer 18

true because it completely involutes by 26 weeks

Question 19

Ependyma?

Answer 19

thin epithelium-like lining of theventricular systemof thebrainand thecentral canalof thespinal cord

Question 20

intracranial hemorrhage grade 1?

Answer 20

subepindymal hemorrhage

Question 21

intracranial hemorrhage type 2?

Answer 21

IVH without ventricular dialation

Question 22

intracranial hemorrhage type 3?

Answer 22

IVH with ventricular dialation

Question 23

intracranial hemorrhage type 4?

Answer 23

• intraparnchymal hemorrhage with or withough ventricular dilation

Question 24

Germinal Matrix Hemorrhage (SEH): Grade I primary site?

Answer 24

caudothalmic groove (CTG)

Question 25

3 steps to scanning a Germinal Matrix Hemorrhage (SEH): Grade I?

Answer 25

A: Parasag scan through the area of the caudothalamic groove shows a focal area of increased echogenicity (arrow) B: Cor. scan - bilateral echogenic foci at the CTG (arrows). C: Resolving grade I hemorrhage. The same infant several weeks later shows clot has undergone cystic liquefaction (arrow).

Question 26

there are long tern neurologic complications with a Germinal Matrix Hemorrhage (SEH): Grade I T or F?

Answer 26

False

Question 27

Grade II Hemorrhage characteristics?

Answer 27

- GMH ruptures through epyndymal lining and enters ventricles - no ventricular dilation

Question 28

Grade II Hemorrhage clot?

Answer 28

- Clot can adhere to normal CP making it appear irregular and thick. - This may be difficult to see on ultrasound - Doppler will show flow in CP, no flow in clot

Question 29

in Grade II Hemorrhage where does blood most often accumulate?

Answer 29

in the most dependent part of ventricle- occipital horn

Question 30

occipital horns are best seen through?

Answer 30

posterior frontanelle

Question 31

Grade II Hemorrhage on u/s?

Answer 31

- echogenic | - material in occipital horn

Question 32

Answer 32

grade III hemorrhage A- Parasag scan shows blood-filled lateral ventricle with clot filling the entire ventricle and forming an echogenic cast of the ventricle (arrow) B- Coronal scan shows clot in both lateral ventricles with hydrocephalus (arrow) C- Same patient 14 days later shows evolution of clot. Coronal scan shows area of liquefaction of clot (arrow) D- Parasag scan shows some retraction of the intraventricular clot.

Question 33

Answer 33

Grade III hemorrhage A- Coronal scan posteriorly - Dilation of the lateral ventricles - Echogenic material (blood clot) in the ventricles B- Coronal scan in the same infant posteriorly - The lateral ventricles are dilated with large amount of intraventricular hemorrhage which, on the - - right, is taking the shape of the ventricle (arrow) C- Sagittal scan of the left lateral ventricle. - The blood clot has settled posteriorly and is lying primarily in the occipital horn - The echogenic CP can be seen separate and anterior to this (arrow).

Question 34

Grade IV Hemorrhage?

Answer 34

- Parenchymal involvement with or without ventricular dilatation - Most common in frontal and parietal lobes - Resorption of hemorrhagic area may lead to formation of porencephaly

Question 35

Porencephaly?

Answer 35

- fluid filled space that have replaced normal brain parenchyma due to destructive process - These cysts rarely resolve

Question 36

long term complications of grade IV hemorrhage?

Answer 36

- cerebral palsy - developmental delays - seizures