13.5 - Neuroradiología: Hidrocefalia, EM, USG Transfontanelar y Rx Cráneo

Summary

This video provides an in-depth exploration of neonatal neuroimaging, focusing on brain hemorrhages in premature infants and the role of diagnostic imaging. It covers the classification of hemorrhages into four grades, ranging from minor subependymal bleeding to severe parenchymal hemorrhages. The importance of identifying hydrocephalus and its causes, such as masses or congenital stenosis, is emphasized. The video also addresses the use of cranial X-rays, noting their limitations in modern medicine, and highlights the importance of advanced imaging techniques like MRI and CT scans in evaluating brain pathology.

Takeaways

• 😀 The classification of intraventricular hemorrhage (IVH) in premature infants is based on the severity of the bleeding, ranging from grade 1 (confined to subependymal regions) to grade 4 (affecting parenchyma).
• 😀 Intraventricular hemorrhage can extend into the ventricles, causing hydrocephalus if it obstructs the absorption of cerebrospinal fluid.
• 😀 Obstructive hydrocephalus can result from a mass in the posterior fossa, as demonstrated by dilated ventricles on imaging.
• 😀 Cranial X-rays are outdated and not useful for evaluating soft tissue or neurological conditions. They are primarily used for bone-related diseases and trauma.
• 😀 Cranial X-rays are still used to assess conditions like metastatic bone disease and some metabolic bone disorders, such as osteogenesis imperfecta.
• 😀 CT and MRI are essential for detailed assessment of neurological conditions, especially in cases of trauma, tumors, and hydrocephalus.
• 😀 The use of cranial X-rays in evaluating children must take into account open sutures and fontanelles, which may obscure fracture detection.
• 😀 In adults, cranial X-rays can evaluate the integrity of bone structures like the sella turcica, frontal sinuses, and the relationship between the cervical spine and skull.
• 😀 The radiological appearance of cranial structures can change with age, with adults often showing thickening of the skull and calcifications, especially in the pineal gland.
• 😀 For advanced neuroradiology knowledge, books by Dr. Ann Osbourne are highly recommended, especially for in-depth understanding of neuroimaging techniques.

Q & A

What is the classification of brain hemorrhages in premature infants, and how are they graded?

Brain hemorrhages in premature infants are classified into four grades. Grade 1 involves a hemorrhage confined to the subependymal region. Grade 2 involves hemorrhage extending into the ventricles. Grade 3 includes larger clots causing obstruction and possible hydrocephalus. Grade 4 involves parenchymal hemorrhage affecting areas like the thalamus and frontal lobe.

What role do plexus choroides play in neonatal brain hemorrhages?

The plexus choroides are echogenic structures, and their involvement in hemorrhage can extend into the ventricles, leading to more severe hemorrhagic complications. This can result in hydrocephalus if the hemorrhage affects cerebrospinal fluid reabsorption.

How can hemorrhages lead to hydrocephalus in premature infants?

Hemorrhages, particularly in grades 3 and 4, can block the reabsorption of cerebrospinal fluid by the choroid plexus, leading to obstructive hydrocephalus, which can cause the lateral ventricles to dilate.

What are the common complications associated with hemorrhages in the cerebellum of premature infants?

Hemorrhages in the cerebellum are common in premature infants and generally worsen the short- and long-term prognosis. These patients often require consultation with neurosurgery specialists.

What imaging method is most commonly used to assess hydrocephalus, and what are the key diagnostic steps?

Ultrasound is the primary imaging method for detecting hydrocephalus in infants. If further details are needed, MRI is used to confirm the presence of masses or other causes of obstructive hydrocephalus, such as congenital aqueductal stenosis.

Why are cranial X-rays no longer commonly used in neuroimaging?

Cranial X-rays are outdated for studying conditions like headaches or tumors, as they only offer limited information on bone integrity. Modern neuroimaging techniques like MRI and CT scans are more reliable for evaluating brain structures.

In what situations would cranial X-rays still be considered useful?

Cranial X-rays may still be used in rare cases, such as evaluating the presence of metastasis in the bones, or for metabolic bone diseases like osteogenesis imperfecta or hyperparathyroidism. They are also used in trauma cases to assess bone fractures.

What potential risks are associated with cranial X-rays?

Cranial X-rays carry the risk of exposing patients to radiation, and for individuals with metallic foreign bodies, such as fragments from machinery, they can also interfere with MRI procedures, potentially leading to further injury.

What is the significance of the calvarial thickening observed in elderly adults on cranial X-rays?

In elderly adults, the thickening of the calvaria (skull cap) seen on cranial X-rays is generally considered normal and physiological. However, it is important to distinguish it from abnormal thickening, which could indicate pathological conditions.

What are some typical calcifications seen on cranial X-rays in adults, and what do they indicate?

Typical calcifications visible on cranial X-rays in adults include those in the pineal gland. These calcifications are common with aging and are generally benign, though they can occasionally be associated with certain neurological conditions.