Neonate Brain Pathology Flashcards
(109 cards)
1
Q
What is the space that contains CSF between the frontal horns of the lateral ventricles?
A
CSP
2
Q
What is the posterior extension of the CSP seen in premies known as?
A
Cavum vergae
2
Q
Is Cavum Veli Interposti (CVI) a normal variant?
A
YES
2
Q
When does the CSP close?
A
6-8 months
3
Q
When does the CSP begin to close?
A
6 months
4
Q
When imaging the CVI, what should you differentiate it from and how?
A
A vein of galen aneurysm and use color doppler to determine
5
Q
Widely spaced sylvian fissures are a marker of what?
A
Extreme prematurity
6
Q
When should we expect to see sulci on ultrasound?
A
26 weeks gestation
7
Q
At what gestational age is the insula fully exposed and sylvian fissures are wide open?
A
Before 24-26 weeks
8
Q
What are the other names for prominent periventricular blush?
A
- Periventricular halo
- Peri-trigonal blush
9
Q
What is the artifact called that is “increased echogenicity in the brain parenchyma around the peri-trigonal area of the ventricles?”
A
Anisotropy
10
Q
When scanning through the anterior fontanelle, you see periventricular blush. What additional window should you look to confirm true blush or if its just artifactual?
A
Posterior fontanelle will confirm
11
Q
If from the posterior fontanelle, we see increased echogenicity within the peri-trigonal area, what abnormality should we suspect?
A
Periventricular leukomalacia (PVL)
12
Q
Are the lateral ventricles typically larger or smaller in preterm babies?
A
Larger in premies
13
Q
When ventricular asymmetry is seen, which side of more often larger?
A
Left is often larger than the right
14
Q
At the level of what landmark are connatal cysts/coarctation of the ventricle usually seen?
A
Foramen of Monroe
15
Q
What is the name for a fold of the frontal horn of the lateral ventricle and is a normal variant?
A
Connatal cyst/ coarctation of the ventricle
16
Q
What is one of the main indications for neonatal brain U/S?
A
Intracranial Hemorrhage (ICH)
17
Q
When do brain bleeds typically occur?
A
Within the first few weeks of life (majority within the first 3 days) in a premature baby
18
Q
What age and weight of premies are MOST at risk of ICH?
A
<32 weeks gestation and <1500g
19
Q
T or F? There is treatment for ICH
A
FALSE: no treatment
20
Q
What consists of loosely arranged proliferating cells that give rise to neurons and glia of the cerebral cortex and basal ganglia?
A
Germinal matrix - gives rise to gray matter later on
21
Q
Where does the GM develop?
A
Below ependymal lining of the ventricles, near foramen of Monroe, and caudate nucleus
22
Q
The GM contains a network of?
A
Immature, fragile blood vessels
23
Hemorrhage of the germinal matrix typically occurs at how many weeks? (hint: range)
24-30 weeks
24
GM hemorrhage has a low risk after how many weeks?
32
25
What is the most prominent portion of the GM?
Caudothalamic groove
26
Where do MOST bleeds originate in the brain?
Caudothalamic groove
27
T or F? A normal germinal matrix can be seen on ultrasound?
FALSE
28
What is a grade 1GM hemorrhage known as?
Subependymal
29
What is the mildest form of GM-IVH
Grade 1: Subependymal - has NO neurological effects
30
What is a grade 2 GM-IVH?
When a GM hemorrhage ruptures through the ependymal lining and enters into the ventricle with NO ventricular dilation
31
How can you determine a clot vs a bulky echogenic choroid plexus?
Colour doppler with show some vascularity within the choroid but is absent with a clot
32
If you see an echogenic area within the frontal or occipital horns of the lateral ventricles, is it most likely a clot or an extension of the choroid?
Most likely a clot
33
In a grade 2 GM-IVH, where does blood usually accumulate?
Occipital horn - most dependent portion
34
When the lining of the ventricles become thick/echogenic after a bleed, what is the irritation termed?
Chemical ventriculitis
35
What is a grade 3 GM-IVH?
Extension of blood into DILATED ventricles
36
What grade of hemorrhage is termed "echogenic cast" (blood filling ventricles) of the ventricle?
Grade 3
37
What is a common complication of grade 3 GM-IVH?
Post-hemorrhagic hydrocephalus (PHH)
38
What structure is seen when the 3rd ventricle is dilated that connects the 2 thalami and could be mistaken for a clot?
Massa intermedia
39
When can the massa intermedia be seen?
When the 3rd ventricle is dilated
40
What pathology is considered to be a result of venous infarction and subsequent hemorrhagic necrosis of the periventricular white matter?
Grade 4 - intra-parenchymal hemorrhage
41
In what lobes are intra-parenchymal hemorrhage IPH most common?
Frontal and parietal lobes
42
What may develop on grade 4 IPH due to clot resorption?
Porencephaly - replaces brain tissue over time
43
What grade(s) of hemorrhage have long term neurologic effects?
Grade 4
44
What kind of neurological effects can occur due to hemorrhage? (3)
1. Cerebral palsy
2. Developmental delays
3. Seizures
45
What is a destructive process where fluid-filled spaces replace brain parenchyma?
Porencephaly - due to grade 4 hemorrhage
46
What is the difference between hydrocephalus and ventriculomegaly?
Hydrocephalus = ventriculomegaly + increased intra-cranial pressure (ICP)
Ventriculomegaly = dilated ventricles WITHOUT increased pressure
47
With an increase in intra-cranial pressure, what may be the outcome? (3)
1. Blood flow obstruction
2. Destroys brain cells
3. Cause herniation
48
What denotes hydrocephalus?
Increased volume of CSF with increased ICP
49
What are the 3 types of hydrocephalus?
1. Intra-ventricular obstructing hydro (IVOH)
2. Extra-ventricular obstructing hydro (EVOH)
3. Choroid plexus papilloma
50
Pair IVOH and EVOH with communicating vs non-communicating
IVOH - non communicating - WITHIN ventricles
EVOH - communicating - OUTSIDE ventricles
51
Where is the most common site for IVOH?
Aqueduct of sylvius- because it is the narrowest part and is more prone to obstruction
52
What are the 3 main reasons for an increase in CSF?
1. Obstruction (IVOH/EVOH)
2. Decreased absorption due to arachnoid villi becoming obstructed
3. Over production - congenital
53
What are the main signs and symptoms of hydrocephalus?
1. Increased head size
2. Bulging anterior fontanelle
54
What is NOT a symptom of hydrocephalus?
a. Separation of cranial sutures
b. Increased ICP
c. Tachycardia
d. Apnea
C - tachycardia is NOT. Bradycardia is a symptom.
55
What is a treatment for increased ICP?
Ventriculoperitoneal shunt (VP)
56
What is a common feature on a spectral waveform to see when a baby has increased ICP?
Diastolic flow reversal in the anterior cerebral artery (ACA) - with or without compression
57
What is a common feature on a spectral waveform to see when a baby has increased ICP?
Diastolic flow reversal in the anterior cerebral artery (ACA) - with or without compression
58
When you see hydrocephalus, you must report the ventricular index (VI) and anterior horn width (AHW) in mm. At what level of the brain do you measure and how are the measurements taken?
Measured at the level of the foramen of Munroe.
VI - measure from the IHF all the way to the edge of the ventricle
AHW - inner to inner measurement of the ventricle - AP measurement
59
What fontanelle is best for visualizing cerebellar hemorrhage?
Mastoid fontanelle
60
What is a common cause of brain injury in neonates?
Hypoxic-ischemic encephalopathy
61
What abnormalities encompass hypoxic-ischemic encephalopathy?
1. PVL
2. Traumatic brain injury/brain death
62
What is the most common hypoxic-ischemic brain injury in premies?
PVL - necrosis or softening of the white matter of the brain
63
What abnormality is known as the infarction and necrosis of the periventricular white matter?
PVL
64
What areas are most affected by PVL?
1. Peri-trigonal area
2. Anterolateral to the frontal horns
65
T or F? PVL is almost always bilateral and symmetric?
TRUE
66
What abnormality usually co-exists with PVL?
GMH/IVH
67
What is the early SF of PVL?
Increased echogenicity surround ventricles - almost like normal blushing
68
What is the later SF of PVL?
Cyst formation without communication within the ventricles
69
The cystic spaces in PVL represent areas of what?
Necrosis and cavitation
70
What is the key difference between cysts due to PVL and porencephalic cysts from IPH?
Cysts due to PVL - NO communication with ventricle
Porencephalic cysts due to IPH - connected to the ventricles
71
The cystic stage in PVL is the most obvious how long after injury?
2-3 weeks after injury
72
Why is MRI better for the later follow-up of PVL?
Gliosis fills the cystic spaces over time and can make the parenchyma look normal on ultrasound
73
What are the two most common extra-axial fluid collections in neonates?
Subarachnoid
Subdural
74
What are common causes of subarachnoid and subdural fluid collections?
Subarachnoid - can be due to macrocrania and in former premies
Subdural - usually a blood collection due to trauma (possibly child abuse)
75
What sign determines a subarachnoid fluid collection and not subdural?
Cortical vein sign - vessels crossing subarachnoid spaces
76
What are extra-axial fluid collections related to birth trauma? (3)
Cephalohematoma - confined within periosteal layer and cannot spread
Caput Succedaneum - Most superficial and just below the skin
Subgaleal hematoma - Above the periosteum and below aponeurosis
77
What fluid collections can and cannot cross sutures?
Cephalohematoma - cannot
Subgaleal hematoma - can
78
Which form of hematoma in the cranium is most serious?
Subgaleal hematoma - can cross sutures and cause more complications
79
At what gestation age does the corpus callosum form?
3-4 months
80
At what gestation age does the corpus callosum form?
3-4 months
81
In partial agenesis, what portion of the corpus callosum will be missing?
Posterior aspect
82
What are the SF of corpus callosum agenesis?
1. Lateral ventricles are widely displaced - far apart
2. Teardrop shape of the lateral ventricles (colpocephaly)
3. "Sunburst sign" - radial arrangement of sulci and gyri above 3rd ventricle
4. Complete or partial absence of the hypoechoic midline band above the 3rd and 4th ventricle
5. Abnormal or absent pericallosal artery
83
What pathology shows the "sunburst sign"?
Agenesis of CC - radial arrangement of sulci and gyri above 3rd ventricle
84
What is the term for a spectrum of anomalies of the posterior fossa?
Dandy-Walker complex
85
Which dandy-walker complex anomaly has hydrocephalus 80% of the time?
Dandy-walker malformation
86
What are the main SF of dandy-walker malformation? (4)
1. Elevated tentorium
2. Cystic dilation of 4th ventricle
3. Partial or complete absence of vermis
4. Small cerebellar hemispheres
87
What are the main SF of dandy-walker variant?
1. Slightly to mod enlarged 4th ventricle
2. Variable hypoplasia of vermis
3. Normal cerebellar hemispheres
4. NO hydrocephalus
88
What part of the brain is involved with Chiari Malformation?
Hindbrain/posterior fossa
89
What is the most common type of Chiari malformation?
Type 2 - usually ALWAYS associated with myelomeningocele
90
What are the SF of Type 2 Chiari malformation?
1. Small posterior fossa
2. Downward displacement of cerebellum, medulla, and 4th ventricle - cannot visualize CM
3. "Bat-wing" appearance - Inferior pointing of the frontal horns of lateral ventricles
4. Hydrocephalus with prominent massa intermedia
5. Colpocephaly
6. Partial or complete absence of CC
91
What is the most common intracranial vascular anomaly presenting in the neonatal period?
Vein of Galen Malformation (VGM)
92
What is the VGM? What arteries feed the malformation?
Midline cerebral AVM causing dilation of the vein of galen. Anterior and posterior cerebral arteries feed.
93
What are the main signs and symptoms of VGM? (2)
1. Bruit
2. CHF
94
SF of VGM?
1. Anechoic to hypoechoic midline mass posterior to 3rd ventricle
2. Turbulent flow of vein of galen - increased flow velocity and dampened pulsatility
95
What part of the brain involves holoprosencephaly?
Forebrain/prosencephalon
96
What pathology is known as the failure of the developing forebrain to divide into 2 separate
cerebral hemispheres?
Holoprosencephaly
97
What are the 3 main types of holoprosencephaly?
1. Alobar - worst
2. Semi-lobar
3. Lobar
98
Many midline craniofacial anomalies are associated with what pathology?
Holoprosencephaly
99
SF of alobar holoprosencephaly?
1. Fused thalamus
2. Absence of CC, IHF, 3rd ventricle
3. Midline monoventricle
100
SF of semi-lobar holoprosencephaly
1. Single lateral ventricle (Occipital and temporal horns may be formed)
2. Small portion of the falx may be present
3. Variable degrees of fusion of thalami
4. 3rd vent is small or absent
101
SF of lobar holoprosencephaly?
1. Fused frontal horns of the lateral ventricles
2. Wide communication with the third ventricle
102
What are the most common neonatal infections?
TORCH
103
What is a common finding with neonatal infections?
Brain calcifications
104
What is Lenticulostriate vasculopathy?
Linear branching of echogenic foci in thalamus/basal ganglia - NOT related to TORCH infections
105
What artery in the COW (circle of willis) supplies most of the blood to the brain?
MCA
106
What is the best window to access the circle of willis (COW)?
Transtemporal window
107
What window is best to view the ACA, pericallosal A, and MCA?
ACA and pericallosal - anterior fontanelle
MCA - Transtemporal
