Neonatal Brain Ultrasound Normal Vs Abnormal Images | Full Term Infant & Premature Newborn Head USG

Summary

Dr. Sam's video delves into neonatal brain ultrasound, focusing on its importance for premature and high-risk infants. It explains the normal brain's appearance in both full-term and premature infants, highlighting key structures like the interhemispheric fissure and the Sylvian fissure. The video also covers various brain pathologies, including hydrocephalus, intracranial hemorrhages, and malformations like Chiari and Dandy-Walker. It discusses the significance of the choroid plexus and the implications of conditions like lissencephaly and porencephaly. The informative content is tailored for medical professionals and those interested in neonatal neurology.

Takeaways

• 🧠 Neonatal brain ultrasounds are crucial for assessing the brain health of premature and high-risk infants.
• 👶 The coronal view is most commonly used in neonatal ultrasounds as it provides detailed images of the brain's structures.
• 🌟 In normal full-term infants, the ultrasound shows distinct features like the interhemispheric fissure, frontal horns, and Sylvian fissure.
• 👶🏻 Premature infants typically have larger lateral ventricles and fewer prominent sulci compared to full-term infants.
• 💧 Hydrocephalus is characterized by the abnormal accumulation of cerebrospinal fluid, leading to enlarged ventricles.
• 🩸 Intracranial hemorrhages, common in premature infants, are often germinal matrix hemorrhages and can be graded from one to four based on severity.
• 🧬 Chiari malformations involve the downward displacement of the cerebellar tonsils and can affect the shape and size of the ventricles and cerebellum.
• 🧲 The choroid plexus, responsible for producing cerebrospinal fluid, can develop cysts or lipomas, which appear as fluid or hyperechoic masses on ultrasound.
• 🧬 Agenesis of the corpus callosum presents with parallel and enlarged lateral ventricles, often with a high-riding third ventricle.
• 🧲 Dandy-Walker malformation is identified by an abnormally wide connection between the fourth ventricle and the cisterna magna, with a dilated fourth ventricle.
• 🩺 Conditions like lissencephaly (smooth brain) and schizencephaly (brain clefts) are characterized by the absence of normal brain sulci and can be distinguished by their ultrasound features.

Q & A

What is the primary purpose of neonatal brain ultrasound?

Neonatal brain ultrasound is primarily performed on premature and high-risk infants to assess brain structures and identify abnormalities such as hemorrhages or enlarged ventricles.

What are the key differences in brain structure between full-term and premature infants on ultrasound?

In premature infants, the lateral ventricles are usually larger, and the sulci are less prominent compared to full-term infants, whose brain structures are more developed with more pronounced sulci.

What is the interhemispheric fissure, and how is it visualized on a neonatal brain ultrasound?

The interhemispheric fissure is a hyper-echoic line seen in coronal views of the brain, separating the two cerebral hemispheres.

What are the grades of germinal matrix hemorrhage in neonates, and how are they characterized?

Germinal matrix hemorrhages are graded from 1 to 4. Grade 1: Hemorrhage outside the ventricle. Grade 2: Hemorrhage extends into the ventricles without dilating them. Grade 3: Hemorrhage extends into the ventricles with dilation (ventriculomegaly). Grade 4: Hemorrhage extends into the brain tissue.

What are some characteristic features of hydrocephalus on neonatal brain ultrasound?

Hydrocephalus is characterized by abnormal accumulation of cerebrospinal fluid (CSF) leading to enlarged lateral ventricles, and in severe cases, dilated temporal horns.

What is the significance of a frontal horn cyst in neonates, and how is it detected?

A frontal horn cyst, also known as coact cyst, is usually a normal variant caused by folding of the frontal horn. It appears as a small cystic structure near the frontal horn on ultrasound.

What are the key features of Chiari II malformation visible on neonatal ultrasound?

Chiari II malformation is characterized by downward displacement of the fourth ventricle, enlargement of the third ventricle, obliteration of the cisterna magna, and a batwing configuration of the lateral ventricles.

How can agenesis of the corpus callosum be identified on neonatal brain ultrasound?

In agenesis of the corpus callosum, the lateral ventricles appear parallel, the third ventricle is displaced upward, and the corpus callosum is absent.

What is porencephaly, and how is it visualized on ultrasound?

Porencephaly is a condition where a cystic lesion is seen communicating with the ventricles. This cystic space connects with the ventricles and can be detected as a fluid-filled area on ultrasound.

What are the characteristics of septo-optic dysplasia on neonatal brain ultrasound?

Septo-optic dysplasia is the mildest form of holoprosencephaly, where the septum pellucidum is absent, and there is fusion of the frontal horns of the lateral ventricles. This leads to a single large ventricle instead of two separate ones.

Outlines

00:00

🧠 Neonatal Brain Ultrasound Basics

The first paragraph introduces neonatal brain ultrasound, commonly performed on premature and high-risk infants. It explains the coronal view, which provides detailed images of the brain. The paragraph compares a normal full-term infant's brain with a premature infant's brain, emphasizing the larger lateral ventricles and fewer sulci in premature infants. Key brain structures like the interhemispheric fissure, frontal horns, septum pellucidum, and Sylvian fissure are described.

05:00

🩺 Brain Anatomy and Pathology

This section dives into the sagittal views of a full-term infant's brain, outlining structures like the corpus callosum, lateral and third ventricles, and brainstem. It then transitions into pathology, starting with hydrocephalus, where cerebrospinal fluid (CSF) accumulates abnormally, leading to enlarged ventricles. Another discussed pathology is germinal matrix hemorrhages, which are common in premature infants and graded from 1 to 4, with increasing severity and involvement of brain tissue.

10:04

⚠️ Brain Malformations and Cysts

This paragraph covers various brain malformations and cystic conditions, such as frontal horn cysts and Chiari malformation. It details how these abnormalities impact structures like the lateral ventricles, third ventricle, and cisterna magna. The discussion also touches on corpus callosum agenesis, where ventricles become parallel due to the absence of the corpus callosum, and conditions like Dandy-Walker malformation, which affects the cerebellum and fourth ventricle.

15:06

🧬 Septo-Optic Dysplasia and Other Severe Conditions

This section focuses on severe brain abnormalities like septo-optic dysplasia, where the septum pellucidum is absent, leading to fused frontal horns. It also describes holoprosencephaly, a condition characterized by varying degrees of fused brain structures, from mild (septo-optic dysplasia) to severe (alobar holoprosencephaly). Other conditions, such as schizencephaly, lisencephaly (smooth brain), porencephaly, and hydranencephaly, are discussed, each characterized by different brain abnormalities and the presence of cysts or missing brain tissue.

🧠 Periventricular Leukomalacia and Infections

The final paragraph examines periventricular leukomalacia (PVL), a condition affecting white matter in the brain, graded from 1 to 4 based on cyst size and severity. Cerebral edema, ventriculitis, and meningitis are also discussed, highlighting their effects on brain tissue and ventricles. The description ends with a note on extra-axial fluid accumulation and thickened meninges in severe infections, emphasizing the importance of recognizing these abnormalities through imaging.

Keywords

💡Neonatology

Neonatology is a subspecialty of pediatrics that focuses on the medical care of newborn infants, especially those who are ill or premature. In the context of the video, neonatology is central to understanding the importance of neonatal brain ultrasound, which is a diagnostic tool used to assess the health of a newborn's brain, particularly in premature or high-risk infants.

💡Ultrasound

Ultrasound, also known as sonography, is a medical imaging technique that uses high-frequency sound waves to create images of the inside of the body. In the video, ultrasound is the primary method for visualizing the brain structures in neonates, providing detailed information about the brain's anatomy and potential abnormalities.

💡Coronal view

The coronal view in medical imaging refers to a perspective that divides the body into front and back sections. The video emphasizes that coronal views are often taken in neonatal brain ultrasound because they provide the most detail about the brain's structure, such as the interhemispheric fissure and the frontal horns of the lateral ventricles.

💡Lateral ventricles

The lateral ventricles are C-shaped cavities within the brain that are filled with cerebrospinal fluid (CSF). In the video, the size and appearance of the lateral ventricles in both full-term and premature infants are discussed, noting that premature infants typically have larger lateral ventricles compared to full-term infants.

💡Sylvian fissure

The Sylvian fissure is a cleft in the brain that separates the frontal and temporal lobes. It is a significant landmark in brain imaging, as mentioned in the video, and can be observed in both normal and pathological conditions of the neonatal brain.

💡Hydranencephaly

Hydranencephaly is a rare and severe brain malformation where much of the cerebral hemispheres are replaced by CSF-filled cavities. The video describes hydranencephaly as a pathology where there is an abnormal accumulation of CSF within the lateral ventricles, leading to dilated ventricles.

💡Intracranial hemorrhage

Intracranial hemorrhage refers to bleeding within the skull, which can occur in various brain structures. The video discusses germinal matrix hemorrhages, a type of intracranial hemorrhage common in premature infants, and how they are classified into four grades based on severity and extent of bleeding.

💡Chiari malformation

Chiari malformation is a structural defect in the cerebellum where the cerebellar tonsils extend into the spinal canal. The video explains how this malformation can be identified on ultrasound by observing a downward displacement of the fourth ventricle and an enlarged massa intermedia.

💡Corpus callosum

The corpus callosum is a band of nerve fibers that connects the two hemispheres of the brain, facilitating communication between them. The video mentions that in certain conditions, such as agenesis of the corpus callosum, this structure may be absent or malformed, leading to characteristic ultrasound findings.

💡Cerebral edema

Cerebral edema is a condition characterized by an excess accumulation of fluid in the brain, leading to increased pressure within the skull. In the video, cerebral edema is described as having a specific ultrasound appearance, with the brain showing increased echogenicity and the ventricles appearing slit-like.

💡Meningitis

Meningitis is an inflammation of the meninges, the protective membranes covering the brain and spinal cord. The video discusses how meningitis can be detected on ultrasound by observing thickened and hyperechoic meninges, as well as fluid accumulation in the subarachnoid spaces.

Highlights

Neonates, especially premature and high-risk infants, often undergo neonatal brain ultrasounds for detailed brain assessments.

Coronal views are most commonly used in neonatal brain ultrasounds due to their detailed brain structure depiction.

Full-term infants typically have smaller lateral ventricles and more prominent sulci compared to premature infants.

Sagittal views of the brain in full-term infants reveal layered structures like the Corpus Callosum and lateral ventricles.

Hydranencephaly is characterized by abnormal CSF accumulation leading to dilated ventricles.

Intracranial hemorrhages in neonates are often Germinal Matrix Hemorrhages, primarily affecting premature infants.

Grade 1 Germinal Matrix Hemorrhage is identified by hyperechoic clots outside the ventricles.

Grade 4 Hemorrhage involves features of lower grades plus hemorrhage extension into the cerebral cortex.

Frontal horn cysts can be a normal variant, also known as coact or conal cysts, formed by folding of the frontal horn.

Chiari II Malformation features downward displacement of the fourth ventricle and an enlarged massa intermedia.

In Chiari II Malformation, the cisterna magna is obliterated, showing a closed space between the vermis and the posterior rim of foramen magnum.

Corpus Callosum agenesis is indicated by a parallel orientation of lateral ventricles, which are also enlarged.

A choroid plexus cyst appears as an anechoic fluid collection inside the choroid plexus.

Dandy Walker Malformation is characterized by an abnormally wide connection between the fourth ventricle and cisterna magna.

Septo-optic dysplasia is the mildest form of holoprosencephaly, with an absent septum pellucidum and fused frontal horns.

In alobar holoprosencephaly, there is a single large ventricle, fused thalami, and very little brain tissue.

Schizencephaly involves clefts within the brain, with open-lipped types communicating with the skull.

Lissencephaly, or Smooth brain, is characterized by the absence of normal brain sulci.

In hydranencephaly, there is a large collection of CSF surrounding the thalamus, with some brain tissue present.

Cystic encephalomalacia is marked by multiple cystic areas in the brain along with septations.

Aqueductal stenosis presents with dilated lateral and third ventricles but a normal fourth ventricle.

Cerebral edema appears as an increased echogenicity of the brain with a slit-like appearance of the ventricles.

Ventriculitis, an inflammation of the ventricles, shows thickened and hyperechoic ventricle walls with dilated ventricles.

Meningitis can be identified by thickened and hyperechoic meninges, with extra-axial fluid accumulation.

Transcripts

hello everyone this is Dr Sam and this

video is about neonatal brain

ultrasound neonatal brain ultrasound is

often performed on premature infants and

high-risk

infants most of the views taken are

coronal as it provides the most detail

about the

brain on the left side is the normal

brain of a full-term infant in coronal V

this hyper aquic line in the middle is

the interhemispheric

fissure these small hypo aquic

structures are the frontal horns of

lateral

ventricles and between these horns is

the septum

paldum this line is the Sylvian

fissure and below that is the temporal

lobe on both sides

and over here is an image of a normal

brain in premature

infant they usually have larger lateral

ventricles as compared to full-term

infants and another difference is the

prominence of

suai premature infants have less number

of sukai seen on

ultrasound whereas a full-term infant

has more prominent sukai

these are sagittal views of a normal

brain in a full-term

infant this layered structure is the

Corpus

skum below that the anic area is the

lateral

ventricle below the lateral ventricle is

the third ventricle right

here as we go down we will find the

midbrain

this is the

pawns and this is medola

oblonga Behind These is the hyperic cell

vermis this is the oipal

lobe this region is the corded

nucleus and this groove is the camic

groove behind the corded nucleus is the

thalmus this hake structure is the choid

plexus which produce cerebral spinal

fluid now we move on to

pathologies the first case is of

hydrus there is abnormal accumulation of

CSF within the lateral

ventricles this leads to dilated

ventricles or ventricul

Meli we see enlarged lateral

ventricles and over here the temporal

horn is also

dilated here is another case of

hydrus we see dilated ventricles with

temporal horns also

dilated most intracranial hemorrhages in

neonates are germinal Matrix

hemorrhages they are also called perent

rular intraventricular

hemorrhages they mostly occur in

premature

infants this has four

grades on grade one the Hemorrhage is

only present Outside The

ventricle we will see hyper aoic cloths

outside the lateral

ventricles this image is in sagittal

view we can see a clot of Outside The

ventricle this is grade 1 germinal

matric

Hemorrhage in grade two the Hemorrhage

will extend into the ventricles but

without ventricul

Meli there are cloths outside and inside

the

ventricles This Is A sagittal view of

great 2 germinal Matrix hemorrhage

we see cloths inside and outside The

ventricle in grade three the Hemorrhage

will extend into the ventricles and take

up to 50% of The

ventricle ventricul mageli will also be

present this is great three Hemorrhage

in sagittal view ventricle is dilated

and there is a greater degree of

intraventricular

Hemorrhage in grade four Hemorrhage all

features of grade 1 2 and three are

present furthermore there is extension

of hemorrhage into the brain tissue the

Hemorrhage is present in the cerebral

cortex a frontal horn cyst can be a

normal variant it is also called coact

or frontal horn and conal

cyst it is usually formed by folding of

the frontal horn on

itself Ki 2 Mal formation has a number

of

features there is downward displacement

of the fourth

ventricle and it is enlarged as

well the Massa intermedia is a linking

tissue between Thalamus and third

ventricle

normally it won't be

visualized but in case of car to

malformation it can become enlarged and

prominent third ventricle is also

dilated cisterna magna is the space

between the vermis and the posterior rim

of foram and Magnum in car to

malformation this space is closed this

is called obliteration of cisterna

magna this is a coronal image we see

dilated lateral and third

ventricles with an abnormally shaped

fourth

ventricle you can see the difference in

shape and location of the fourth

ventricle bad wi configuration of

lateral ventricles is another

feature this is due to pointed frontal

horns cpoy can also occur this ventricle

is large and has a specific teardrop

shape this is a coronal image showing

coloi it is different from batwing sign

because it has a more rounded

shape this image shows the posterior

aspect of the

brain this hyper aoic structure is the

glomus of choid

plexus it is basically the largest part

and down here is the

cerebellum in a Genesis of Corpus kosum

we will see parallel orientation of

lateral

ventricles you will see that the

ventricles are in a straight line and

are parallel to each other

they are also

enlarged in this sagittal view we can

see that the Corpus Clum is

absent a high riding third ventricle is

also present it is higher than its usual

location another feature is the widely

spaced and separated frontal

horns you can see these horns are much

further above

from each

other a choroid plexus cyst will appear

as an anqui fluid collection inside the

choid

plexus a corpus kosum lipoma will appear

as a hyper aquic mass at the

interhemispheric

fissure this Mass usually does not cause

Mass

Effect similarly a choid plexus lipoma

may also occur it appears as a hyperic

mass at the choid

plexus this is an aial view of a normal

brain showing the

cerebellum the fourth ventricle and the

hyper aoic cerebellar

vermis this anic region is the sisterna

Magna in Dandy Walker Mal formation

there is an abnormal wide connection

between fourth ventricle and cisterna

magna the fourth ventricle is

dilated in mega sisterna Magna we will

see a large anic region behind the

cerebellum it is a normal

variant it is usually diagnosed when

cisterna magna measures 10 mm or

more here is an exal view of Mega

sisterna

Magna we can see a large anake region

behind the

cerebellum septo optic dysplasia is the

mildest form of holoen SEI which has a

series of brain

abnormalities in this form the septum

paldum is absent and we see fused

frontal horns of lateral

ventricle instead of two separate horns

we see a large fused

ventricle this is septo optic dysplasia

in sagittal view we only see a large

ventricle other structures seem normal

Al loer

holen is the most severe type we will

see a single large

ventricle and fused

thalami the interhemispheric fissure is

absent the third ventricle is also

absent and there is a very small amount

of brain

tissue semi lobber holoen sephi is less

severe than the aler

type a single ventricle is

present the thmi are also fused but we

do see an interhemispheric

fissure it is not complete but it is

still

present more brain tissue is found as

compared to the alob

type in

Skeen clefts are found within the brain

it has two types open lipped and Clos

lipped in the open Li type the white

cerebral Clift is communicating with the

ventricle and the

skull the Clift has reached the skull

bone in the closed lip type the Clift is

connected to the ventricle but not the

skull you can see this Clift is just

around the

ventricle listen Sly is a condition in

which there is absence of brain

sulai it is also called Smooth

brain here is a sagittal view of listen

Sly we do not see the normal brain sulai

like we see in the normal

image in poren Seely

a cystic Legion is seen communicating

with the

ventricle the cyst is connected to the

ventricle in hydran and seph there is a

large collection of CSF surrounding the

thalmus it looks like Hol proen Seely

but there is a

difference Fox cerebri is present here

whereas in Hol proen sephi Fox rebry is

absent some brain tissue is also found

here this is A sagittal view showing

hydran and

sephy we see a large collection of

CSF and some brain

tissue cystic and seph Malaysia is a

condition in which there are multiple

cystic areas in the brain along with

formation of

septations multiple Cs and septations

are

seen here is a cedal view showing cystic

and seph

Malaysia we see various cyst and septs

within the

brain in aqueductal stenosis the lateral

and third ventricles are

dilated but the fourth ventricle is

normal

This Is A sagittal view we see dilated

third

ventricle the lateral ventricle is not

in

view and the fourth ventricle is

normal this is a case of acute cerebral

hemorrhage hyperic bright areas are seen

within the

cereum this is the hemorrhage

sub aroid Hemorrhage can also be

visualized on ultrasound in some

cases we will find hyperic Hemorrhage

around the

cerebellum in the sisterna

Magna this is a coronal image of a

normal brain of a premature

infant this is the choid

plexus periventricular lucose

malaa affects white matter of the

brain it is graded based on

severity in grade one hyperic areas are

seen outside the

ventricles no cystic areas are

found in grade two we will see multiple

small cysts outside the ventricles in

addition to the hyper aquic areas

in grade three the number of Cy is

increased and the hyper aquic areas also

take up a larger

area grade four has large CS the size of

the cyst has greatly

increased appearances of cerebral edema

include coarse brain eot

texture rough areas that are slightly

hyper aquic are

seen the ventricles are difficult to

visualize they have a slitlike

appearance this is a seal view of

cerebral

edema there is an overall increased

echogenicity of the

brain lots of bright areas are

seen ventriculitis is the inflammation

of ventric

Les the wall of The ventricle will be

thickened and appear hyper

aoic another feature is stranding of the

wall tissue in the

ventricles the ventricles are much more

dilated in this

image this image shows the normal

frontal lobe of the

brain and over here we have meningitis

the meninges are thickened and Hyper

aquic even the sulai are thick and Hyper

aquic some fluid accumulation is also

seen here this is called extra exal

fluid thick suprasellar systs will also

be

found you can see the difference in

thickness of the

ssts thank you so much for watching

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