ASA 2022 Melbourne Conference - Neonatal Neurosonography
Summary
TLDRIn this informative lecture, Henry delves into neonatal neural sonography, covering the essentials of technique, anatomy, and pathology. He highlights the importance of probe selection and scanning approaches, then transitions into a detailed exploration of neonatal brain pathologies, including hemorrhage grading, hydrocephalus, and various congenital anomalies. The presentation is a valuable resource for medical professionals seeking to enhance their understanding of neonatal brain ultrasounds.
Takeaways
- 🌟 Neonatal neural sonography is divided into two main sections: basic technique and anatomy, and pathology.
- 🔍 High-frequency transducers are essential for neonatal neural sonography to ensure good image resolution, with micro-convex array transducers being the speaker's preferred choice.
- 👶 Indications for neonatal cranial ultrasound include prematurity, low Apgar scores, neurological changes, cranial dysmorphisms, and follow-up for known hemorrhages or other pathologies.
- 📚 Key sonographic features to learn include the inter-hemisphere fissure, sylvian fissures, cavum septum pellucidum, corpus callosum, basal ganglia, ventricular system, and cerebellum.
- 🧠 The cavum septum pellucidum is a fetal neural developmental marker that is normally present and can be associated with CNS anomalies if absent.
- 🔑 The corpus callosum is the largest white matter structure, connecting both hemispheres of the brain and playing a role in eye movement, cognition, and tactile localization.
- 🚫 Germinal matrix hemorrhages typically occur in the sub-ependymal region and are a significant concern due to their potential to cause severe neurological deficits.
- 🌐 The ventricular system, consisting of the lateral, third, and fourth ventricles, is essential for the circulation of cerebrospinal fluid and can be affected by various pathologies.
- 💉 The extra-axial spaces are important for identifying collections such as subdural or epidural hemorrhages, and benign enlargement of the arachnoid spaces.
- 🔍 Scanning techniques involve using the anterior fontanelle for obtaining coronal and sagittal views, with attention to detail to avoid missing critical findings.
- 🩸 Intraventricular hemorrhage (IVH) is a primary concern in neonatal brain ultrasounds, especially in extremely premature infants, and is graded from one to four, with grade four being the most severe.
Q & A
What are the two main sections covered in Henry's lecture on neonatal neural sonography?
-The two main sections covered in Henry's lecture are the basics of neonatal neural sonography, which includes technique, anatomy, and the second section on pathology.
What type of transducer does Henry recommend for neonatal neural sonography?
-Henry recommends using a high-frequency transducer for good resolution in neonatal neural sonography, with a preference for micro-convex array transducers that usually range from three to ten megahertz.
What are the primary indications for neonatal cranial ultrasound?
-The primary indications for neonatal cranial ultrasound include prematurity, low Apgar scores, any neurological changes upon or during admission, cranial dysmorphisms such as macrocephaly or microcephaly, craniosynostosis, and follow-up for known hemorrhages or other pathologies.
What is the cavum septum pellucidum and why is it significant in neonatal sonography?
-The cavum septum pellucidum is a midline cystic structure between the anterior horns of the lateral ventricles and is a fetal neural developmental marker. It is present in normal brains and its absence has been associated with central nervous system anomalies like septo-optic dysplasia, holoprosencephaly, and agenesis of the corpus callosum.
What is the significance of the corpus callosum in the brain and what does it consist of?
-The corpus callosum is a horizontal bundle of nerve fibers that connects both hemispheres of the brain and is the largest white matter structure, consisting of over 200 million axons. It plays a crucial role in eye movement, cognition, and tactile localization.
What is the germinal matrix, and why is it important in neonatal brain scans?
-The germinal matrix is a highly vascularized thin membrane located in the sub-ependymal region of the cytothalamic groove. It is important because it is the starting point for germinal matrix hemorrhages, which can occur in premature infants.
What are the key features of the ventricular system in the brain, and why are they important in neonatal sonography?
-The ventricular system consists of the lateral ventricles, the third ventricle, and the fourth ventricle. These are chambers filled with cerebrospinal fluid and contain the choroid plexus, which creates the fluid. They are important in neonatal sonography to check for abnormalities such as hydrocephalus or hemorrhages.
What is the significance of the extra axial spaces in neonatal sonography?
-The extra axial spaces are important in neonatal sonography because they can have collections from benign enlargement of the arachnoid spaces, which is a common cause of microcephaly, up to and including subdural or epidural hemorrhages.
Can you explain the grading system for intraventricular hemorrhages (IVH) in neonatal patients?
-The grading system for IVH consists of four grades. Grade one is the least severe, with bleeding contained within the germinal matrix. Grade two indicates bleeding has broken into the ventricle but occupies less than 50% of the ventricular space without ventricular dilatation. Grade three involves bleeding occupying more than 50% of the ventricle or causing ventricular enlargement. Grade four is the most severe, characterized by intraparenchymal or periventricular hemorrhage within the brain tissue itself.
What are some risk factors for intraventricular hemorrhage in neonatal patients?
-Risk factors for intraventricular hemorrhage include prematurity (less than 32 weeks, especially if extreme, and less than 1500 grams), rapid fluctuations in blood pressure or blood volume, transfer from outside facilities, coagulopathy or blood clotting disorders, respiratory distress, and hypoxic ischemic events.
Outlines
📚 Introduction to Neonatal Neural Sonography
Henry begins the lecture by expressing gratitude to the ASA for the opportunity to speak and introduces the topic of neonatal neural sonography. The lecture is divided into two sections: basic technique, anatomy, and a subsequent pathology section. The objectives include a detailed overview of neuroanatomy, techniques, probe selection, and scanning approaches. Henry emphasizes the importance of using a high-frequency transducer for better resolution in neonatal sonography and discusses the advantages of micro-convex array transducers over sector probes for imaging detail. Indications for neonatal cranial ultrasound are also outlined, such as prematurity, low Apgar scores, neurological changes, and cranial dysmorphisms. Key sonographic features to observe include various brain structures and fissures, with a diagram provided for clarity.
🔍 Probe Selection and Neonatal Cranial Ultrasound Indications
This paragraph delves into the specifics of probe selection for neonatal neural sonography, highlighting the use of high-resolution linear probes for detailed imaging. Henry discusses the challenges of imaging as babies grow and their fontanels decrease in size. Indications for neonatal cranial ultrasound are expanded upon, with a focus on the importance of monitoring for hemorrhages, especially in premature infants. Key sonographic features are described in detail, including the interhemispheric fissure, sylvian fissures, cavum septum pellucidum, corpus callosum, basal ganglia, ventricular system, and cerebellum. A diagram is used to illustrate the brain lobes and corresponding bones, providing a visual aid for understanding the anatomy.
🧠 Detailed Exploration of Brain Structures and Pathology
Henry provides an in-depth look at various brain structures, including the germinal matrix, a critical area for the development of hemorrhages, and the ventricular system, which comprises chambers filled with cerebral spinal fluid. He explains the importance of the choroid plexus, a network of cells that produce and filter cerebrospinal fluid. Scanning techniques are discussed, with a focus on the anterior fontanelle as the primary scanning window, and the importance of obtaining clear, angled images to avoid missing critical details. The paragraph concludes with a detailed explanation of how to perform a comprehensive scan, including the order and technique for obtaining coronal and sagittal views.
📘 Sagittal and Parasagittal Views in Neonatal Sonography
The lecture continues with a focus on sagittal and parasagittal views in neonatal sonography. Henry describes the process of scanning, starting with the midline and moving to the right and left, highlighting the importance of obtaining six images to cover all necessary areas. He provides detailed descriptions of what can be observed in these views, such as the corpus callosum, thalamic adhesion, third ventricle, cerebellar vermis, and fourth ventricle. The use of different probes is discussed, with a preference for linear transducers for their ability to reveal subtle structures. The paragraph concludes with an overview of the vascular anatomy, including the circle of Willis and the blood flow in major cerebral arteries.
🩸 Neonatal Neuropathology and Hemorrhage Grading
Henry transitions to the second part of the lecture, focusing on neonatal neuropathology, particularly the prevalence and significance of hemorrhage in neonatal brain ultrasounds. He explains that hemorrhage is the primary reason for conducting these ultrasounds, especially in extremely premature infants. The lecture covers the grading system for hemorrhages, ranging from grade one to grade four, with each grade indicating increasing severity and potential outcomes. Risk factors for hemorrhage are discussed, including prematurity, blood pressure fluctuations, and coagulopathy. The paragraph concludes with a visual representation of hemorrhage grades and their typical locations within the brain.
🛑 Advanced Imaging of Neonatal Hemorrhages and Outcomes
This paragraph provides a detailed examination of the progression and outcomes of neonatal hemorrhages. Henry discusses how grade one hemorrhages can progress to higher grades and the potential for cystic degeneration over time. He describes the process of blood clot retraction and the formation of cystic spaces, which may eventually lead to subependymal cysts. The paragraph also covers the evolution of grade two hemorrhages, which involve blood breaking into the ventricles without causing ventricular dilatation, and the potential long-term effects, such as calcified plaques and the development of hydrocephalus in more severe cases like grade three hemorrhages.
🧊 Cystic Degeneration and Hydrocephalus in Neonatal Pathology
Henry discusses the process of cystic degeneration following hemorrhages and the development of hydrocephalus, a condition characterized by abnormal accumulation of cerebrospinal fluid in the ventricles. He explains that hydrocephalus can result from various causes, including post-hemorrhagic obstruction. The paragraph details the imaging findings in hydrocephalus, including the dilation of the trigone and occipital horn, and the potential need for a VP shunt or reservoir to manage the condition. Henry emphasizes the importance of early diagnosis and intervention to prevent complications such as encephalomalacia and brain damage due to increased pressure.
🧬 Congenital Anomalies and Their Sonographic Features
The lecture shifts focus to congenital anomalies, with Henry providing an overview of various conditions, including agenesis of the corpus callosum, holoprosencephaly, hydranencephaly, and schizencephaly. He describes the sonographic features of these anomalies, such as the 'moose head' appearance in agenesis of the corpus callosum and the monoventricle in holoprosencephaly. The paragraph also touches on the risk factors and prognosis associated with these conditions, highlighting the importance of accurate diagnosis and the potential impact on patient outcomes.
🦄 Advanced Congenital Anomalies and Neuropathology
Henry concludes the lecture with a discussion on additional congenital anomalies and their impact on neonatal neuropathology. He describes conditions such as schizocephaly, lissencephaly, and pachygyria, emphasizing their unique imaging characteristics and the importance of recognizing these features in sonography. The paragraph also covers the Walker-Warburg syndrome, which is associated with cobblestone lissencephaly, and its typical presentation, including hydrocephalus and cerebellar malformations. The lecture ends with a reminder of the vast range of pathologies that can be encountered in neonatal neuroanatomy and neuropathology.
Mindmap
Keywords
💡Neonatal Neural Sonography
💡Transducer
💡Interhemisphere Fissure
💡Corpus Callosum
💡Cavum Septum Pellucidum
💡Germinal Matrix
💡Intraventricular Hemorrhage (IVH)
💡Hydrocephalus
💡Holoprosencephaly
💡Lissencephaly
💡Doppler Ultrasound
Highlights
Introduction to neonatal neural sonography, covering basics, technique, anatomy, and pathology.
Use of high-frequency transducers for better resolution in neonatal neural sonography.
Explanation of probe selection, including micro-convex array transducers and linear probes for high-resolution imaging.
Indications for neonatal cranial ultrasound, such as prematurity, low Apgar scores, and cranial dysmorphisms.
Key sonographic features to observe, including inter-hemisphere fissure, sylvian fissures, and cavum septum pellucidum.
Importance of the corpus callosum in neonatal brain imaging and its components.
Significance of the germinal matrix in hemorrhage occurrence and its relation to the cytothalamic region.
Description of the ventricular system, including the lateral, third, and fourth ventricles.
Scanning techniques and windows for neonatal brain ultrasound, emphasizing the anterior fontanelle.
Overview of neonatal neuropathology, focusing on hemorrhage as the primary reason for brain ultrasounds.
Grading system for intraventricular hemorrhages and their respective severities and outcomes.
Risk factors associated with hemorrhages, including prematurity and fluctuations in blood pressure.
Discussion on the progression and outcomes of hemorrhage grades, from grade one to grade four.
Identification and differentiation of core plexus cysts and their association with trisomy 18.
Overview of hypoxic-ischemic injury in neonates and its sonographic markers.
Presentation of periventricular leukomalacia (PVL) and its impact on white matter.
Discussion on hydrocephalus, its causes, and the importance of monitoring ventricular size.
Overview of extra-axial spaces in neonatal brain imaging and their clinical significance.
Brief on congenital anomalies such as agenesis of the corpus callosum and holoprosencephaly.
Conclusion summarizing the extensive range of pathologies covered in neonatal neuroanatomy and neuropathology.
Transcripts
hello everyone i'm henry and thank you
for joining me i want to thank the asa
for giving me the opportunity to speak
it is quite the honor today i'm going to
be talking about neonatal neural
sonography and it's going to be broken
down into two sections the first section
is just going to be the basics technique
anatomy and then the second video will
be on pathology so lecture objectives
like i said already anatomy we're going
to a detailed overview of the
neuroanatomy techniques probe selection
scanning approaches and then in the
second video pathology all right so
probe choice now when you're doing
neonatal neural sonography you want to
use a
high measure transducer to get good
resolution and we have small probes that
are just for that like this sector that
goes up to 10 megahertz uh my favorite
are these little curved ones the micro
convex array transducers uh they're
usually from three to ten megahertz they
take very very good images much better
than the sector probes in my opinion and
then finally linear probes to get those
really nice high resolution uh images
here you can see the difference from a
sector probe in a parasagital view
and the linear you can see so much more
detail with the linear obviously
the older the baby gets the bigger the
baby's brain gets or their head gets and
the smaller their fontanels get using a
linear is less feasible
all right so indications for neonatal
cranial ultrasound prematurity is
probably the number one reason to do
these exams uh any premature infant less
than 32 weeks or less than 15
100 grams is at an increased risk for
hemorrhage
low abgar scores any neurological change
upon admission or during admission
cranial dysmorphisms so macrocephaly
microcephaly craniosynostosis
uh and follow-up for known hemorrhages
or other pathology
key sonographic features that you want
to pay attention to and learn are the
inter hemisphere fissure
the sylvian fissures also known as the
lateral sulcus
cavum septa lucidum
corpus callosum
basal ganglia especially the
cytothalamic region
the ventricular system so the ventricles
and the cerebellum so here is the
diagram i made of the lobes pretty
simple
yellow is frontal
green is a parietal lobe purple is a
temporal lobe and orange is the
occipital lobe each lobe is has its
corresponding bone
and then you have the cerebellum and
brain stem
so let's begin with the inter hemisphere
fissure
the inter hemisphere fissure is an
invagination or a deep groove
of the dura mater and the tentorium is
also an invagination of the dural matter
that separates the cerebrum to the
cerebellum
the intra-hemispheric fissure is also
called false cerebri and it separates
both hemispheres of the brain
once it goes down it eventually meets up
with the corpus callosum
all right
sylvian fissures are lateral grooves
their deep lateral grooves are on the
temporal region they separate the
frontal occipital lobes to the temporal
lobes they look like sideways wise i
always tell my students and the insula
is buried deep to it
let's go back real quick so here you
have the temporal
temporal lobes
cavim septum pellucidum or cavum septi
pellucidai is a midline cystic structure
in between the anterior horns of the
lateral ventricles it is a fetal neural
developmental marker so when you're
doing fetal scans it's one of the things
we look for
uh it's present in normal brains
people who do fetal scans are very well
familiar with with the structure
absence of this structure has been
associated with central nervous system
anomalies like septo-optic dysplasia
holoprosencephaly and corpus callosum a
genesis
it usually fuses by six months
uh it is present in a lot of newborn
infants we see it quite a lot it's a
normal structure and it persists in 15
of adults
it is not that it really obliterates is
that just as you grow up and your grain
bags gets bigger
the lateral you know all the structures
get kind of closer together and you
can't really make it out like you can in
fetuses and in neonates
so here we have a sagittal and a coronal
view and that's the cavum septum
pellucidum right there and in corona and
then we have a gross pathology example
in coronal also showing the anterior
horns of the lateral ventricles
and the caveman septum pellucidum
so kevin vergie
is one that not everyone is familiar
with um if you do a lot of brain
ultrasounds you will be familiar with
this but it's a continuation of the the
csp
it's usually
posterior and beneath the splenium and
body of the corpus callosum here you can
see the csp and cavenfree
it is present 30 in infants and present
in less than one percent of adults here
you can see the normal csp
with
without the cavendriki in this patient
then we have the cavin veli
interpositive or cavan vellum
interpositum
it is a supercententorial cystic
structure
it is antero inferior to the splenium of
the corpus callosum so it's more
inferior more posterior than the cave
and fergie
um there's no associated congenital
anomalies
and here is its structure right here
anytime you do see this it's good to put
color doppler because this is an area
where you can have a regular cysts quite
commonly and also a vein of galen
aneurysm could be present in this
portion here
so you can put color doppler to rule
that out
all right so the corpus callosum very
important structure it's a horizontal
bundle of nerve fibers that connects
both hemispheres of the brain
it is the largest white matter structure
consists of over 200 million axons
its components are the rostrum the genu
the body and the splenium from anterior
to posterior
it is important for eye movement
cognition and tactile localization
and it is reportedly larger in females
maybe that's why women are more smarter
so here you have a coronal view of the
corpus callosum
and here's a sagittal zoomed up view
there you can see the rostrum is like a
little beak portion right there and then
you got the genu which was right here
the whole body and then the splenium
splenium is towards the back it's
posterior i use i usually remind the
students that think uh when you're
trying to scan the spleen
sometimes you gotta scan more posterior
to get a good spleen image
and splenium is posterior to the back
all right so the germinal matrix very
important structure that is highly
vascularized thin membrane and it's
important for us because this is where
the
germinal matrix hemorrhages begin so the
bleeds it is located in the
sub-ependymal region of the cytothalamic
groove so where the cardiac nucleus and
the thalamus meet it is a source for
neuronal precursors that constitute
brain parenchyma which what that means
is primitive nerve cells begin here and
then they migrate outwards and here is
that counterthylamic groove so
parasagittal you got the cauday nucleus
here
the thalamus and then this portion right
here that's where the catothalamic
groove is germinal matrix is
and if you do have a bleed that's where
it's going to be so it'll be a germinal
matrix hemorrhage or a sub ependymal
hemorrhage which subappendable meaning
under the lining of the ventricle
here is with a diagram
and it's important to note
that the echogenicity of the chlorate
plexus is going to be very similar to
great wood bleeds
but the location is important the cory
plexus usually begins about
one third to halfway
of the thalamus and then it tapers
there
so if you have this there a lot of
people when they first start scanning
they confuse that with blood that's not
blood that's the core plexus so the
location here if you have a little hump
there that's echogenic then nothing then
the core plexus that part is the blood
all right so now let's go to the
ventricular system so the ventricles are
just a series of chambers inside the
brain that are filled with cerebral
spinal fluid they contain the core
plexus as well which create that
cerebral spinal fluid there's the
prepared lateral ventricles
the third ventricle and the fourth
ventricle so here's a diagram of the
ventricular system in a parasagittal
view and a coronal view so here you got
the lateral ventricles which would be
anterior horn occipital horn temporal
horn and then you have the third
ventricle
this little structure is where the
thalamic adhesion or massa intermediate
is so pretty much the midline of the
thalamus
and then you have several foramen and
channels that connect the ventricles
like the foramen of monroe
and the aqueduct of silvius or the
cerebral aqueduct that goes down into
the fourth ventricle
and here is a diagram of a parasagital
view of the lateral ventricle so again
anterior horn
posterior horn or occipital horn
temporal horn and the cory plexus
and here's a coronal view
showing the anterior horns of the
lateral ventricles the foramen of
mineral on each side and the third
ventricles the larger the baby is the
less you're gonna be able to see these
structures
so here we have the third ventricle in
midline sagittal so let's go back
in corona the third ventricle is like a
slit
and then in sagittal it looks broader
obviously and more premature uh infants
you're gonna see it easier in larger
kids you're not gonna see it as well
so is this structure right here
that's the third ventricle this is the
masa intermedia or the thalamic adhesion
which would go right there
and then from here you have the cerebral
aqueduct or the aqueduct the silvius
which goes into the fourth ventricle
then the posterior fossa and then into
the spinal cord
so that's aqueduct silvius and the
fourth ventricle which is always
triangular shaped and anterior to the
cerebellum midline of the cerebellum
which would be the vermis
so extra axial spaces are important
because you can have collections there
from benign enlargement of the arachnoid
spaces which is common and common cause
of microcephaly
up to and including
um subdural hemorrhages or
epidural hemorrhages
and here you can see the layers so this
is the dermis this is the skin
then you have the dura mater
then the arachnoid space
and the pia mater around the brain so
these three layers are the meninges and
i use dap as a mnemonic to remember dap
dura arachnoid pia i'll go over some
more detailed images of these spaces
later on so the corey plexus very
important it is a network of epithelial
cells
capillaries and connective tissue that
creates the cerebral spinal fluid it
also filters wastes it is located in the
lateral ventricles as you can see here
it is also located in the third
ventricle on the roof of the third
ventricle and the fourth ventricle and
they're hyperechoic
so now let's go into scanning windows so
the standard windows that we scan is the
most important is anterior fontanelle so
here we have a a fetal neonatal skull
and you can see the parietal bones the
frontal bones the parietal bones and
then what would become the sutures and
the anterior fontanelle so if you put
the transducer right there
and just
right there and rocket anterior to
posterior you can get all the coronal
images you want the notch or the
indicator of the transducer to be on the
patient's right side
and then when you're sagittal you want
the notch facing anterior and then same
rocking motion side to side you can get
your sagittal and parasagital views
so we begin our exam with six coronal
views from interior to posterior as you
can see doing that fanning motion
oftentimes you don't even have to move
the transducer just
tilting it and fanning like that you can
get all the images you need obviously
also pivoting and rotating to get your
image as straight as possible because if
the baby's moving or if you're angled or
you're off axis you're not gonna have
you're gonna have a very tilted image
which is not
you know it's not as aesthetically
pleasing and you might miss something as
well so all the way anterior is where we
begin and you can see the frontal horns
the periventricular white matter inter
hemisphere fissure
the cranium
which kind of looks like a bird swooping
down that's why they you know they
trained me i don't or top me and then
the orbits
but i like to know i like to prefer to
know the real anatomy
so again intermittent fissure and the
frontal lobes
and there you can see that
that bird swooping down i guess it's
like a dove or something i don't know
all right so more posteriorly you'll
start to begin to get the little
temporal horns the cave and septum
pollution you see how this is a term
baby and how tiny the lateral ventricles
are antihermosphere fissure and corpus
callosum
so corpus callosum looks like a blue
macaroni into hemispheric fissure
caveman septum pellucidum the lateral
ventricles frontal lobes and the
temporal lobes and one of the sylvian
fissures seen relatively clearly this is
with the sector probe like i said before
with the with the
the micro curve the ray probe the images
are just fantastic this one's with a
linear see how much prettier so again
sylveon fissures this is just slightly
more posterior back
you got the supercellular cistern right
here
thalamus cutting nucleus
so bleeds would start around here in
coronal
temporal lobes midbrain
cingulate sulcus
and then the sylvian fissures which
already said
and then that blue
macaroni
corpus callosum
slightly posterior back
again you have the lateral ventricles
earlier i mentioned that the third the
third ventricle has cory plexus and the
roof of the third ventricle and you can
see that pretty clearly there
so third ventricle
lateral ventricles corpus callosum
very clear with a nine megahertz
transducer
frame of mineral on both sides
there's more angling more posterior now
you start to get a tentorium
so you have cerebellum tentorium
lateral ventricles with a little bit of
cory plexus in it and this is important
to note because when you first start
scanning these you might go here and if
you're inexperienced you'll see that and
you're like oh no that's is that a bleed
but you got to know your position um
this is more posterior
the caudate groove is anterior to this
and the bleeds usually be a little bit
bigger than that
so again civilian figures or lateral
sulcus
then slightly more posterior to the
level of the cory plexus so you got your
lateral ventricles here corey plexus
into hemispheric fissure
a piece of the corpus callosum and
finally
all the way posterior so here you've got
your interim for your fissure occipital
lobe and periventricular white matter
so those are the coronal views next are
the sagittal views
so the way we scan we usually begin
sagittal midline then go to the right
and then go to the left also six images
um
kind of duplicating the midline when you
come back from the right now some places
some people start in the right and
they'll sweep all the way through every
place is a little bit different but you
want to get
these images
so beginning sagittal midline again you
have the corpus callosum right here
thalamic adhesion third ventricle
cerebellar vermicus
fourth ventricle and here's with the
labeling
corpus callosum again rostrum genu body
and splenium csp carbon cave and fergie
here is the cerebral aqueduct or
aqueduct of silvius
this part here is known as a fornix
this is with a linear transducer again
you got the corpus callosum the ecogenic
fornix right here above the thalamus and
then you also see the pons the medulla
oblongata midbrain and brain stem
sometimes it's very hard to make out
these structures
uh in bigger babies and uh more
premature and neonates you can
definitely see it here you got the
cerebellum again and the fourth
ventricle always triangular shaped
so then you begin parasagittal to the
right
parasitical to the left so your first
stop is the caudate nucleus or
catathalamic groove which we saw this
image earlier
focus on this part for bleeds
then you got the
lateral ventricle again enter your horn
body occipital horn and temper horn with
cor uh corey plexus
this is a good part sometimes blood
collects here that's another good parts
to view
and then all the way lateral you're
gonna get the periventricular white
matter the sylvian fissure or lateral
sulcus in parasagittal separating the
frontal occipital lobes to the temporal
lobes and here's the view of the extra
axial space again you see there's some
some fluid here which is normal this is
the
superior sagittal sinus and you can see
there's like little echogenic lines here
those are vessels those are perforating
vessels in the arachnoid matter and
that's normal so again it would be dura
mater arachnoid space and then pia mater
on the brain
so another view is the posterior
fontanelle
and that's where i said earlier you can
use that view if there's any blood
collecting in the occipital horn you
might not be able to see it from the
anterior fontanelle this is a good view
to check there
here you got two views corey plexus
lateral ventricle and the occipital horn
right here
then you have the temporal window which
is going to give you a bipartial
diameter type view like the one you
would get in a fetus
obviously whatever you're approaching
from is the side that's closest to the
face of the transducer so this is the
baby's left side
so this would be the left side of the
head but obviously on this exam this is
right temporal so i usually approach
from the right temporal unless a baby
has some dressings or something like
that
so you can see the sylvian fissures
right here the lateral sulcus
here you got the csp lateral ventricles
intra-hemispheric fissure
a little bit of the cerebellum and
midbrain
and you got a little bit of third
ventricle as
well then you have the mastoid view
this is good for looking at the
cerebellum and posterior fossa so if you
have any posterior phosphates or you
know cerebellar
hemorrhages or anything like that this
is a good view and here's the the gross
anatomy view of the cerebellum you see
the fourth ventricle right there fourth
ventricle cerebellar vermis right in the
middle
very nice view
lastly we'll do a basic overview of the
of the vascular anatomy so this is
through that same temporal window you're
going to get the circle of willis this
is in a in an infant and you got the
middle cerebral artery anterior cerebral
arteries on both sides and the posterior
cerebral arteries which is usually
subdivided into segments p1 and p2 so
circle of willis
and the blood flow or the arterial
velocity in these arteries usually go
highest from mca to pca so mca then aca
then pca and velocity ascending to
descending the normal resistive index is
greater than 0.6 which is important
because in
patients that have
hypoxia or hypoxic ischemic
encephalopathy they'll normally have
lower resistive indices due to
brain-sparing effects so they're going
to be receiving a lot more blood flow so
that's an indicator of hypoxia
and here's a transverse view with the
circle of willis again middle cerebral
arteries right there posterior arteries
basilar artery and then the two
vertebral arteries
so here we have sagittal midline
and coronal
so this is very nice you can see the
internal carotid artery you can almost
see maybe the ophthalmic artery coming
off of there then that goes the ica goes
up into the brain bifurcates into aca
and mca so in sagittal midline you see
the aca
which then goes on to become the
pericalosa artery so here your corpus
callosum periclosal artery
then you have your internal cerebral
vein and your vein of galen so vanilla
and very important also four aneurysms
and then you got the straight sinus and
here you have corona again circle of
willis middle cerebral arteries
anterior cerebral arteries and the
terminal internal carotid arteries
in that view if you angle posteriorly
you'll be able to see the the basilar
artery going into the circle of willis
so that pretty much concludes the
anatomical and technical aspect of this
talk welcome to the second portion of
this video we're gonna go over neonatal
neuropathology
so the number one reason to do neonatal
brain ultrasounds is hemorrhage
particularly interventricular or
intraventricular hemorrhage
now 45 of extreme premature infants so
as infants below 28 weeks or under a
thousand grams
develop intraventricular hemorrhages
it is thought to be caused from impaired
or autoregulation so these patients they
have these germinal matrices
that are very delicate
any change in pressure pressure or blood
volume can cause those little
capillaries and blood vessels to rupture
leading to hemorrhage fifty percent of
bleeds usually happen on the first day
and by the fourth day ninety percent of
all beliefs that are going to happen
have already happened
so the prevalence of intraventricular
hemorrhage
by grade is grade one seventeen 17
grade 2 12
grade 3 3
and grade 4 3 or 3.8 percent now
obviously the the lower the grade the
better it is for the baby and the more
common it is
so this privileges of all bleeds
all right so risk factors are
prematurity so less than 32 weeks
especially if you're extreme premature
and less than 1500 grams
rapid fluctuations in blood pressure or
blood volume
transfer from outside facilities has
been known to uh correlate with
increased risk of hemorrhages
any type of coagulopathy or blood
clotting disorders
respiratory distress
and hypoxic ischemic events
now the grading system of bleeds
consists of four grades grade one
through grade four grade one being the
less severe and grade four being the
most severe
grade one through grade three
are thought to begin in the
subappendible region and then break into
the ventricles whereas grade four is
thought to be from venous infarction in
the parenchyma itself
so we're gonna go over them all this is
a quick overview so this is a normal
brain
this is not to be confused with blood
this is the
the
cory plexus and the roof of the third
ventricle then you have a grade one
which is just containing
blood within the germinal matrix or the
sub-ependymal region you see this side
there's two bleeds and here's the
corresponding image
and then here's a grade two
so the bleeds a little larger is broken
into the ventricle it's taking up less
than fifty percent of the ventricular
space
and there is no ventricular dilatation
or ventricular megaly
so grade 3 is also a intraventricular
hemorrhage
with
greater than 50 of the vegetable being
taken up by blood
and or ventricular ventriculomegaly
and then grade four which is an
intraparenchymal or periventricular
hemorrhage is just blood within the
parenchyma
so grade one here's a gross anatomy view
or gross pathology view you see the
blood right here this is the ladder of
ventricles septum pellucidum
so it is limited to the sub-ependymal or
germinal matrix region it's usually less
than a centimeter um if no progression
the outcome of this condition is as if
they never had a bleed so great ones
usually have pretty good outcomes pretty
good prognosis
um 80 of grade ones can uh progress into
higher grades
so here's that same image bilateral
grade one and it's good to see it in
coronal and sagittal earlier i mentioned
that the corey plexus begins about one
third or halfway to the thalamus so this
is choreoplexus and this is in a grade
one bleed you can see that geneticity is
very similar
here's another example of a left-sided
grade one bleed so here's your thalamus
caude nucleus so you see this little
groove right here that's where the blood
is
and it's right there sometimes it's a
little harder to see in coronal and
easier to see in sagittal
so this is a 30 wing a 31 week
premature infant
measuring about 1500 grams
over time the bleeds can involute and
undergo degeneration so if they
don't progress to grade two or grade
three they just stay there and
eventually the blood clot starts to
retract and you have these little cystic
spaces and that's just cystic
degeneration over time there may be a
sub-ependymal cyst that's left over in
his place
in fact sometimes when you scan infants
you'll notice a subappendable cyst which
is different from a choriplexist and
that could be maybe that this p the baby
had or the fetus had a bleed or grade
one in utero that just has resolved and
what's left over is a sub ependymal cyst
all right so grade two
once the blood has gone from the general
matrix and broken into the ventricle
you have a grade two
so
you're not gonna have ventricular megaly
so the vegetables are not gonna be very
large they're gonna be normal sized
and the blood can make a cast of the
portion of the ventricle that it's in
as you can kind of see right here this
but it's taking up some space here
and this is a great too
right there is within the ventricle and
you can see here
it's taking up a good portion of the
ventricle
but the ventricles are not enlarged this
is that same patient the initial exam
you see the blood within the ventricle
without ventricular dilatation and then
you can see the blood clot involuting
and contra retracting over a period of
two weeks
and undergoing cystic degeneration as
well and then finally two months later
all that was left was this calcified
plaque here attached to the corey plexus
no ventricular megaly the ventricles are
very small slit like
as you'd expect
grade three
grade 3 is much more severe
it's going to be taking up a lot of the
ventricle and also causing ventricular
enlargement
so it's ivh with ventricular megaly
the ventricular lining can become
echogenic
that's considered ventriculitis over
time the blood products can cause
irritation and cause the
ventricular lining to become more
egogenic and thicker
there's a 20 increase in mortality once
a patient gets at grade three
and a 35 percent increase in
neurological deficits things like
cerebral palsy uh developmental delay
so here you go you got blood right here
here's your thalamus here's your cory
plexus there's a nice
chunk of blood right there and you can
see the entire ventricle is filled with
echogenic material that is
coagulating blood that hasn't coagulated
completely yet
and there's also ventricular dilatation
and then this is the same patient six
months later
and this patient was 34 weeks
gestational age and they weighed
uh 19 27 grams when they were born so
six months later
see the ventricles are kind of prominent
and there's no more blood but there's
good development of the brain there's
gyra and sulci everywhere
and then grade four is intraparenchymal
so a grade four is can happen
just in the parenchyma or involve the
ventricles and the parenchyma so
intraparamob bleed
white matter venous infarct is what they
believe is what causes it
eventually once that blood uh
you know resolves a fluid-filled cavity
will be left in its place
that's a process called encephalomalacia
and the cavity that's left is usually
called a pore encephalic cyst
grade four bleeds have a 50 chance of
mortality
and 90
increase in neurological deficits
so it is the most severe of all the
bleeds
and carries a lot of morbidity and
mortality
here's a very you could tell 27 weeks
gestational age so extreme preemie
you see this is very there's no sulky or
gyrite pretty much
immature brain you see this large
amount of blood within the parenchyma
there's also blood within the ventricle
and there's midline shift so the midline
is being shifted to the left that's
caused from increased pressure which
causes further cerebral tissue damage so
here you see the blood within the
parenchyma and then blood within the
ventricle
here's another one on the opposite side
so you got all this blood here in the
parenchyma
right there here's a perpendicular white
matter region
and then over time you can see it start
to undergo cystic degeneration
and there's also ventricular megaly now
this is two weeks after there's blood
within the ventricle as well
and then over time once the patient's
healed four month interval you can see
there's a large cystic space that's a
poor encephalitis cyst the cystic space
usually connects to the ventricular
system
and it's just filled with cerebral
spinal fluid
here's another one very premature infant
you see the soviet fissures here other
than that not much gyri or sulci
enter hemispheric fissure here and you
can see day one
day two and by day three those are bleed
so remember earlier usually fifty
percent of bleeds happen on the first
day
by the third or fourth day almost all
the bleeds have happened so here's the
blood
on the right side
here you can see it extending from the
ventricle and into the tissue so there's
blood within the ventricle and blood
within the tissue this is cory plexus
not to be mistaken with blood
and over time day 7 and then day 28 you
can see it undergoing cystic
degeneration this one will also have a
pore encephalic cyst like the other
like the other case
this is a patient that presented with
hypoxia
at the very first exam their initial
exam there's no gray white matter
differentiation you can't really make
out any of the structures
this is caused from edema
over time they developed a large
parenchymal hemorrhage on the left
right here all this you can see there's
also midline shift
here's a parenchymal bleed that begins
around the area of the cerebellum in
between the tentorium and the brain or
cerebrum
you see the the structure right here
and transverse
and then in sagittal and you can also
see it is causing
hydrocephalus or ventricular megaly
because it's obstructing the flow of
cerebral spinal fluid
all right so corey plexus cysts
very common
they occur within the chlorine plexus
they are not true cis as they don't have
an epithelial lining
they're pretty commonly seen prenatally
and also in neonates
there has been some association with
trisomy 18
but if no other abnormality is found on
the the fetal ultrasound there's about a
one percent chance that that's that
coreplex assist would be associated with
trisomy 18. if there's other anomalous
features or other markers there's a
about a four percent chance increase of
association with trisomy but still not
very much the increased risk is
essentially the same whether there is a
single choroplex assist or multiple
cysts so if we see a coriplex with two
cysts that doesn't shouldn't raise
concern for anomalies
however
fit up to 15
50 of patients with trisomy 18 have
coreplex assist
but that's a causation versus
correlation issue
and here's a small example of a
choriplex assist
on the right coryplexus very common all
right so cory plexus papilloma
is a rare neuroectodermal tumor
it is a benign tumor does have some
malignant potential but very low
malignant potential
it is most commonly seen in patients
under five years
and is most commonly seen in infants
uh presenting symptoms could be or
science can be macrocephaly
hydrocephalus alter mental status
it is the third most common after or the
third most common brain tumor after
teratoma and it represents about one
percent of all brain tumors
and two to six percent of all pediatric
brain tumors
so here we have a newborn that
presented with microcephaly
and you can see here there's ventricular
megaly and this large
tumor
coming off of the corey plexus and it
turned out to be a choroid plexus
papilloma so here we have her sagittal
and your coronal views and it's on the
left side
it's very big
and as such it's also causing
obstruction which leads to hydrocephalus
so hypoxic ischemic injury it's a very
important condition that happens when
babies are born and they are lacking
oxygen for whatever reason uh they
usually have apogas scores of zero to
three
greater than five minutes
they often present with seizures coma
and or hypohypotonia
associated material conditions are
pre-eclampsia
fetal infections drug and alcohol abuse
maternal drug and alcohol abuse severe
fetal anemia cardiac disease lung
malformations or problems with blood
flow to the placenta
it is estimated prevalence of one to
three per 1 000 life births
redistribution of blood to the brain may
lead to multi-organ failure
initially the sonograms look normal but
it's important to look uh and doppler
the cerebral arteries the anterior
cerebral artery and the middle cerebral
artery and look for the resistive
indices if they're equal or less than
0.55 in the first 72 hours that
indicates
hypoxic ischemic injury of the brain
sometimes you can also see echogenic
lesions within the basal ganglia like
the thalamus or the cardia nucleus but
you might need to use a linear
transistor to see those times i've done
patients that have hypoxic ischemic
injuries
and the brain looks normal with the
curved probe of the microcurve probe and
you use the linear and it shows some
echogenic lesions within the basal
ganglia
you can also develop little echogenic
lesions in the periventricular white
matter too these are usually due to
infarcts and they definitely present
after they are going to be there
all right so this was a
newborn with cardiac arrest and you can
see the initial
dopplers were of low resistive indices
and eventually the baby went on to have
brain death and those reversal of flow
in the cerebral arteries and you can see
the edema in the sylvian fissure
now when you're doppling the
cerebral arteries it's important to know
the patient's cardiac status because if
they have a pain inductive arteriosis
that might change the waveform and cause
some some reversal of flow in some cases
but this one they obviously had good
diastolic flow
with low resistance indices which is
usually due to brain sparing effect and
then they developed reversal flow
which means that the capillary beds of
the of the brain are closed
here's a 32-week gestational age uh
uh baby who had a biophysical profile
uh low score biophysical profile and
then had a cardiac arrest at birth
and here you see the echogenic lesions
around the ventricles ventricles are
prominent and then they became very
enlarged and you see how those echogenic
lesions eventually start to become
cystic those are infarcts
here's another baby with
hypoxia
at birth and you see again
there's no differentiation between the
green and white matter the brain looks
smudgy
that's a sign of edema and then three
months later you see just how much
brain damage there was there's cystic
encephalomatia all over the brain
increase subdural fluid
increased fluid in the centaurium
just a lot of cerebral damage
all right onto periventricular
leukomalacia or pvl our povl is a white
matter disease usually caused from white
matter infarctions
the the periventricular white matter is
normally echogenic as you can see here
um it's less echogenic than the cory
plexus and this is also called the
periventricular blush
now early on in the stages of
ventricular leukomalacia
it can be a little hard to tell
obviously the more premature the infant
is the higher risk they got
and that's why we do serial ultrasounds
if this is expected you know if the
echogenicity of the ventricular white
matter is a little increased they can do
serial ultrasounds to see if they do
eventually end up developing cystic
spaces within the periventricular white
matter which is what would be pvl
typically cystic changes appear about
two to six weeks after the vascular
insult
and these patients also have significant
significant neuromotor impairments
here you have a patient that whose
initial exam looked much like the other
ones very smudgy brain
echogenic
sulci
then
brain stayed looking edematous
with ventricular enlargement and then
eventually they developed
periventricular leukomalacia two months
later you see all these cystic spaces
here's another one
25-week gestational age 720 grams
extremely premature
the initial exams were normal
perivecular white matter looked pretty
decent and the serial exams immediately
started to get some echogenicity
increased echogenicity in the
periventricular white matter
which ended up developing into cystic
spaces which is
pvl or periventricular leukomalacia so
you see out here it's normal and
parasagittal then you start to have all
these little electrogenic spaces
which then become cystic spaces
all right hydrocephalus hydrocephalus is
pretty common uh is an abnormal
accumulation of cerebral spinal fluid
in the ventricles with ventricular
ventricular megaly so the ventricles get
enlarged
there are four types communicating
non-communicating ex vacuole and normal
pressure
uh depending on the severity they may
require a vp shunt or a reservoir to be
placed in to reduce
that uh ventricular megaly which then
puts pressure on the brain which can
lead to brain damage
another cause of hydrocephalus is post
hemorrhagic hydrocephalus and it results
from mechanical obstruction by blood
within the lower parts of the
ventricular system
the trigone and the occipital horn are
the first to dilate
the incidence in surviving infants
that's infants have had
ivh is estimated to be around 15 percent
so around 50 of babies who develop
intraventricular hemorrhage go on to
develop post hemorrhagic hydrocephalus
and 10 to 20 of those patients require a
ventro ventricular peritoneal shunt or a
reservoir to reduce that fluid
here we've got a piece of a case of very
large ventricles so ventricular megaly
and this is important why we need to
you know
get these hydrocephalus cases treated
because the increased blood pressu
because the increased pressure on the
brain can lead to cystic encephalon
encephalomalacia as well so here you see
you've got very large ventricles and the
parenchyma of the brain is very cystic
so lots of white matter disease
here's another case of hydrocephalus
very large ventricles
you can see how thin the parenchyma is
this isn't transverse you can see the
cory plexus oftentimes depending on the
position of the head you can see the the
coreplex is actually dangling
and here's the same patient with a
reservoir
so we went over the extract scale
species real quickly in the other video
but it's good to know again we also
observe and monitor the extra axial
spaces
for increased fluid or blood
this is with the 24 megahertz transducer
off the new ge logic e10 and you can see
the the skin
this is a cranium here cranium here from
here to here is anterior fontanelle this
is a superior sagittal sinus and this is
the arachnoid space so arachnoid space
and then pia mater and then the dura
so if you had fluid above this it would
be subdural but since there's fluid
below this is within the arachnoid space
it's normal and that is a tiny amount so
tiny that you can't even see it this is
with the 9l
you can't even see that fluid
accumulation but with the 24 makers
transducer you can see it
this is the patient we went over on the
other slides and you see the vessels
within the arachnoid matter
and then this is the dura right here
so this is this one is these are normal
and these are benign enlargement of the
subarachnoid spaces this probably
wouldn't even be considered that it's
usually a little bit more than that
here we have
fluid collections on both parietal lobes
right
and then with the 18 megahertz
transducer
you can see
the pia mater
you could also see the arachnoid space
because he has echogenic and he's got
these little vessels when you put the
colored upper you can see the blood
vessels within the arachnoid space and
then this anechoic region here this is
the subdural space so this is subdural
fluid it's usually most likely a
subdural hygroma
sometimes you if there if there's
echogenic fluid there it could be a
subdural hematoma and here's your
superior sagittal sinus again
here's another case with very very large
extra axial space
compression of the brain
this is a subdural hygroma
and due to the increased intracranial
pressure from this extra fluid
you can see that there's some cystic or
porophilic cyst or cystic
encephalomalacia of the of the cerebral
tissue
all right so arachnoid cysts are fluid
filled
sacs with arachnoid lining
they're common they're more common in
males to females at a two to one ratio
and they're often seen prenatally
incidentally and often they are
asymptomatic this is one of the
more normal locations for them
and you can see this is these are
prenatal images in our place we do is
pediatrics but we do women that come for
fetal mris we do their the fetal
ultrasound before they get the mri so
this is the same patient with the mri
so that's an arachnoid cyst
all right so congenital anomalies
there's a very very long list of
congenital anomalies i'm gonna go over a
few
due to the time constraints
so beginning with a genesis of the
corpus callosum
it is rare about one in four thousand
individuals and with a male to female
ratio of two to one
now you can have a genesis of the corpus
callosum which is no corpus callosum at
all it doesn't develop or you can have a
hypoplastic
uh part of the of the corpus callosum
this is called this genesis
usually we have a genesis of the corpus
callosum you're going to have an
enlarged third ventricle or more
prominent appearing third ventricle
it happens usually between the 12th and
the 16th to 20th weeks of gestation
posteriorly you're going to have
copocephali which is enlargement of the
lateral ventricles in a teardrop shaped
fashion
and in coronal you're gonna have a
bullhorn
or a mousse head appearance of the
anterior horns of the lateral ventricles
they look like a u and this because
they're more separate than than usual
there's also another sign called the
race car sign
for that separation of the lateral
ventricles as well
maternal alcohol consumption is a risk
factor
so here we have a sagittal view with the
normal corpus normal corpus callosum
and then we have a sagittal view with
the corpus callosum agenesis so you see
there's a third ventricle and no corpus
callosum and also the gyrite they raid
they radiate instead of going peri
colossal and then lateral or horizontal
they radiate in this fashion
here's a cro here's a coronal view
showing the core uh corpus callosum
right there so into hemispheric fissure
corpse callosum and then here you have
inter hemisphere fissure norco no corpus
callosum
dilated third ventricle and you see the
the two anterior horns the lateral
ventricles are very separated here's
another case where the anterior portion
so the rostrum and genu of the corpus
callosum seem pretty well formed and
then the posterior aspect of it the
splenium
and body
don't see very don't seem very well
formed
it's very thin
and here we have an example of that same
case
so we see the moose head appearance or
the race car sign
and then more posterior you can see
the copulcephaly or the teardrop shaped
ventricles
and here's a side-by-side view of the
ultrasound and mri
you see a teardrop shaped ventricles
there
all right so next up is hollow
procencephaly it is rare there's an
incidence of one per ten thousand to
sixteen thousand light births and a zero
point two percent incidence rate
um the prosencephalon fails to develop
into two hemispheres in this condition
and there's three types there's lobar
semilobar and a lobar
and here you can see the continuum from
normal
to a low bar a low bar being the most
severe one
so a low bar holoprosencephaly i said is
the most severe form it is often
associated with cyclopia
so you have one eye or two eyes fused in
one to one socket proboscis which is a
you know usually protrusion onto the
forehead or around the nose
so it is considered a mono ventricle in
all three cases just in a low bar is
very prominent
there's no cerebral hemispheres there's
no mid lane there's no uh inter
hemispheric fissure
the thalamus
is fused and all the midline structure
are are also fused and the prognosis is
poor
next up is semilobar holoprosencephaly
it is the middle subtype
you can have agenesis or hypoplasia of
the corpus callosum
you have fusion of the frontal and
parietal lobes with separation of the
occipital lobes the prognosis is better
than a lobar so again you have thalamic
fusion and you know the midline
structures will be fused you do have a
bit of an inter-hemispheric fissure
not a clearly seen corpus callosum maybe
some there in the splenium and body
all right and you see the anterior
portion of the brain is completely fused
there's no inter hemisphere fissure
separating the lobes
and then the most common is low bar
holoprosencephaly so less severe type
the fox is present all the way down up
to the up to the corpus callosum you
won't have a caveman septum to plucidum
the anterior horns are fused
you can't have a hypoplastic corpus
callosum as well
and here's a prenatal example of lobar
holoprosencephaly there you can see
there's no certain pellucidum
the anterior horns are fused
but there is a hemispheric fissure
present so the fox is present and there
is corpus callosum
and posteriorly the ventricles do divide
into two separate structures
following up is hydron encephalin
also rare with the 0.2 rate of incidence
it results in a vascular insult after
the 12th week usually of the internal
carotid arteries
you can't have a falx midbrain and below
will be present so you have membrane you
can have basal ganglia you can have
brain stem pons but you're not going to
have any cerebral hemispheres you can
have a fox with just an empty sac fill
the cerebral spinal fluid it is not to
be mistaken with hydrocephalus or
anencephaly there are cases of
hydrocephalus that are so severe that it
appears
that there is a hydranencephaly but even
in those cases you can see a sliver of
cerebral tissue
of the either right or left cerebral
lobe
um and in anencephaly there is no
cranium and it's just flat there's no
brain and the
the head is flat
uh the prognosis is poor and many babies
are still born with hydrogen encephalin
so here we have a case and here you see
the centaurium
and below the centaurium you can see
not very clear structure but you can see
there's mid-brain structures there and
you see there's no cerebral hemispheres
at all you see some maybe thalamic
structures there
and there is cerebellum
and here you can see the falx and just
fluid
so here you see cerebellum
uh pons midbrain fourth ventricle but no
cerebral hemispheres whatsoever
next up is schizocephaly
another rare condition with about 1.5
per 100 000 life births
it is a cortical malformation that
creates a cleft that's lined with gray
matter from the ependyma to the pia
mater there's two types open lipped and
closed-lipped
here's a fetal view showing
these areas here
and this cleft shaped area here that's
schizocephaly
here's a postnatal ultrasound showing
this area here which is schizocephaly
and you see it's on the right lateral
part so here's into hemisphere fissure
and you can see
the split right here
and here's a prenatal example of
holoprosencephaly and schizocephaly so
here you can see the monoventricle
right no hemispheres and then all this
is schizoincephaly so next up is
licincephaly pachygeria complex
now listencephaly is a neuronal
migration disorder resulting in a smooth
brain so there's no gyrite or sulci
aegeria would be no gyrae whatsoever
pachygeria would be broad gyrate and
then less encephalitis is just a smooth
brain surface
now when babies are born very very very
premature their brains almost look like
they have less encephalitis but you can
see as they develop their brain will
start to
create gyri and sulci whereas somebody
who has less encephali
they'll be full term and their brain
will look very smooth so there's two
types which is type one is classically
encephality but it's rare about 11.7
per million births
uh presenting symptoms and signs are
usually hypotonia seizures and
microcephaly usually develops uh by one
year of age
and then type two is cobblestoneless
encephalin which
the smooth brain but the cortical of
tissue has a bumpy surface and it's
associated with walker water break
syndrome and muscle eye brain disease
so here's a full term baby for two weeks
2950 grams they have a grade one bleed
but if you notice their brain is very
smooth so this is the appearance of a
brain of a very premature infant but
they're 40 weeks full term and full
weight and you see there's just no
gyrations
or sulci
and here's another one that on first
on first appearances might give the
appearance of absent cave and septum
pelucidum which it is there is no cave
in something to blossom or so maybe uh
you know mono ventricles so maybe
holoprosencephaly but as you can see
here cavemcet and pellucidum a genesis
there's also some third ventricular
enlargement
and
from the posterior occipital view you
can see that there's a cystic structure
here
that connects right here so there's
vermin hypoplasia or a genesis and a
posterior phosphate extending outwards
which is a posterior encephalocele and
also if you look this is a full term
baby you can see that the brain is very
smooth
it lacks gyri and sulci
so this is a case of walker warburg
syndrome
which is sometimes known as heart
syndrome it is a lethal form of
congenital muscular dystrophy they
typically have hydrocephalus
neuronal migration anomalies are present
so algeria or lysocephaly most likely
cobblestone listens heavily
they'll have a dandy walker continuum
they also have retinal dysplasia a
posterior encephalocele and cerebellar
malformations
all right so that concludes this
presentation
the list of pathologies that can be
found in neuroanatomy and neuropathology
are very very vast
i just hope i can covered a good amount
of pathology maybe some stuff that you
guys haven't seen before and again i
want to thank the asa for inviting me to
speak it has been quite the honor you
guys can follow me on
sonographictendencies.com
on instagram sonographic tendencies
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have any questions or comments please
feel free to
direct message me on instagram i answer
all my messages all right thank you so
much and take care
تصفح المزيد من مقاطع الفيديو ذات الصلة
Neonatal Neurosonography | Anatomy and Protocol
Neonatal Brain Ultrasound Normal Vs Abnormal Images | Full Term Infant & Premature Newborn Head USG
Ultrasound of the Neonatal Head and Spine | GE Healthcare
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IDEAL Position of Endotracheal Tubes, UACs and UVCs on X-rays!!
ALTERAÇÕES BUCAIS EM RECÉM-NASCIDOS
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