Chapters 31,32,33 & 22 Review
Holoprosenecephaly sono findings:
Single ventricle, fused thalami, absent CSP and corpus callosum, absent falx, variable fusion with less severe forms.
Lissencephaly sono findings:
Smooth brain
Which of the following defines a grade III hemorrhage?
Subependymal hemorrhage with extension into the ventricle with ventriculomegaly.
What refers to a femoral head that is shallow in location, allowing it to glide within the confines of the acetabulum?
Subluxation of the hip
Infant position:
Supine or lateral decubitus, blosters can be used
A pathologic fixation of the spinal cord in an abnormal caudal location is the definition of:
Tethered cord
What view is taken at the lateral aspect of the infant with the transducer oriented parallel to the long axis of the body with the hip at a 90 degree angle?
Coronal/ flexion view
What views are combined with stress maneuvers for evaluation of hip stability?
Coronal/flexion, transverse/flexion
Name the specific Views:
Coronal/neutral view Coronal/flexion view Transverse/flexion view
This is the tract of fibers that connects the cerebral hemispheres and allows the transfer of sensory, motor, and cognitive information between them:
Corpus Callosum
Myelomeningocele symptoms and sono:
Cutaneous stigmata, sacral dimple; possible loss of bladder or bowel control; possible partial or complete paralysis of legs; weakness of hips, legs, or feet; possible clubfoot; possible hydrocephalus. Sono: Sac containing echogenic material representing neural tissue and membranes.
The bony acetabulum consists of which?
Illium, ischium, and pubis
Filar Cyst symptoms and sono:
Incidental finding Sono: Well-defined, midline, cystic collection Normal variant that has no known clinical significance when it occurs alone.
SONO of PVL:
Increased echogenicity in periventricular parenchyma that becomes cystic over time
Periventricular Leukomalacia (PVL):
Infarction and necrosis of the periventricular white matter
Ortolani maneuver:
Involves ABDUCTION-pulled anteriorly "click"
Barlow maneuver:
Involves ADDUCTION-posterior push
Hypoxic-Ischemic Encephalopathy:
Is a brain injury that is due to birth asphyxia that results in significant mortality and long-term morbidity in neonates. Occurs secondary to decreased blood flow.
Hydromyelia:
Is the abnormal widening of the central canal by the CSF. May be either focal or diffuse
What is the purpose of early treatment of abnormal hips?
It is done so that the hips can develop normally
What is an acceptable termination point of the conus medullaris in a normal patient?
L1
Transverse/Flexion View: ABNORMAL
Lacks the "U" appearance because the femoral head shifts laterally with subluxation and posterolaterally with dislocation.
What transducer would you use for a hip exam?
Linear with highest frequency
Indications for neonatal spine sonography:
Lipoma, sacral dimple, sacral skin defect, palpable subcuatenous sacral mass, hair tuft, skin tag, hemangioma, sinus tract, skin pigmentation
Failure of the sulci and gyri to develop in a term infant is associated with which cranial anomaly?
Lissencephaly- Smooth brain
Pavlik Harness:
MOST COMMON device used in the treatment of hip dysplasia in infants that have hip subluxations and reducible dislocations.
Holoprosencephaly:
Midline malformation that results from failure of the forebrain to separate or cleave into two cerebral hemispheres.
Coronal/Neutral View: ABNORMAL
Migrates laterally and superiorly
What is the treatment of newborn laxity?
No treatment, unless significant instability or dislocation
Suspected abnormal growth or development of the spinal cord and adjacent structures is known as:
Occult spinal dysraphism
The hip is comprised of:
The femoral head and acetabulum
What is the DDH treatment?
To position hips so that the femoral head and the acetabulum are aligned correctly
What does the Pavlik harness prevent?
adduction of the hips
Galeazzi or Allis sign is?
is when the subluxed or dislocated hip appears shorter
The key to diagnosis of tethered cord is the sonographic visualization of the level of the:
Conus medullaris
Hip instability is associated with?
joint laxity and may be identified in newborns affected by maternal hormones
In DDH which side is affected more commonly?
left
Coronal/Flexion View:
Coronal View Hip is flexed at 90 degree angle Sono. appearance similar to coronal/neutral view with the exception of visualization of the bony metaphysis
A sonogram is not recommended before ____ to _____ weeks of age to avoid over-treatment.
3 to 4 (During first year of life or until ossification of the femoral head presents visualization)
Coronal/Neutral View: NORMAL
A normal hip shows the hypoechoic femoral head resting against the acetabulum.
Radial arrangement of the sulci superior to the third ventricle is a sono. finding associated with what anomaly?
Abesent corpus callosum (ACC)
Abesent Corpus Callosum sono. findings: (ACC)
Abesent corpus callosum and CSP, mild ventriculomegaly with dilated occipital horns; lateral displacement of lateral ventricles and superior displacement of third ventricle; dilated third ventricle; cingulate gyri radiate in sunburst pattern.
An insult between the weeks of 8 and 20 could result in what?
Agenesis of the corpus callosum
As an infant grows, a tethered cord causes increasing tension leading to:
Ambulation problems
Transverse/Flexion View: NORMAL
Appears to have a U-Shaped configuration as the metaphysis and ischium, surround the femoral head.
Clinical findings for DDH:
Asymmetrical folds One knee is lower than the other when hips and knees are flexed. Affected leg is shorter than the unaffected Limited abduction of the hip
Which maneuver is performed to solicit subluxation?
Barlow maneuver
Diastematomyelia symptoms and sono:
Commonly associated with vertebral column abnormality and tethered spinal cord. Sono: Appearance of two separate smaller spinal cords within spinal canal; hemicords are hypoecoic with echogenic central canal similar to normal spinal cord but smaller.
Tortocollis:
Category of disorders that exhibit flexion, extension, or twisting of muscles of the neck beyond their normal position.
A boy born at 32 weeks gest. age is diagnosed with hydranencephaly. Which cranial structure would be absent?
Cerebrum
What is represented as the downward displacement of the cerebellum and brainstem in association with a myelomeningocele, resulting in a small posterior fossa?
Chiari II Malformation
The sonographic "bat-wing" sign is associated with what cranial anomaly?
Chiari II malformation
Schizencephaly sono findings:
Cleft in brain parenchyma from midline to calvaria
What is characterized by the absence of the cerebellar vermis and dilation of the fourth ventricle with connection to the posterior fossa cyst:
Dandy Walker malformation
A cranial sonogram is performed because of an abnormal prenatal scan. Routine coronal and sagittal views are performed through the anterior fontanelle. Additional scanning through the mastoid fontanelle reveals hypoplasia of the cerebellar vermis and communication between the fourth ventricle and posterior fossa. These findings would be consistent with which anomaly?
Dandy-Walker variant
What does DDH stand for?
Developmental dysplasia of the hip
An incomplete or complete longitudinal split or cleft through the spinal cord is the definition of:
Disatematomyelia
What term describes the type of hip abnormality in which the femoral head sits outside the confines of the acetabulum?
Dislocation
Treatments for DDH:
Double-diaper technique Pavlik Harness (most common)
In a normal patient, the cauda equina nerve branches are the nerve fibers arising from the distal end of the spinal cord and sonographically appear:
Echogenic and oscillate with respiration
Which anatomic structure would aid in the differentiation of alobar holoprosencephaly from hydraenencephaly?
Falx (because flax, corpus callosum & 3rd vent are absent and thalami are fused in alobar-also seen in mono ventricle.)
A normal variant that has no known clinical significance when it occurs alone is a:
Filar cyst
Hydranencephaly sono findings:
Fluid-filled cranium; falx and brainstem may be identified
Where is the MOST COMMON location for the origin of intracranial hemorrhage?
Germinal matrix
Hemorrhage: GRADES
Grade I: Echogenic subependymal head Grade II: Blood within ventricle Grade III: Blood within ventricle with ventricular enlargement Grade IV: Intraventricular blood extending into the parenchyma
A premature infant born at 28 weeks gestational age is scanned to rule out intracranial hemorrhage. The sonogram demonstrates echogenic material within normal-sized ventricles. This finding would be consisted with which pathology?
Grade II hemorrhage
Development of Ventriculomegaly:
Grade III hemorrhage
Transverse/Flexion View:
Hips flexed at 90 degree angle Transducer rotated at 90 degrees from a coronal to a transverse plane and slightly posterolaterally over the hip. Image shows femoral head and metaphysis identified anterior to the femoral head; ischium identified posterior to femoral head.
What is a midline malformation that results from failure of the forebrain to separate or cleave into two cerebral hemispheres.
Holoprosencephaly
What is the MOST COMMON congenital malformation of the forebrain and midface?
Holoprosencephaly
What is described as in utero destruction of the cerebral hemispheres, most likely related to internal carotid artery occlusion.
Hydranencephaly
What is termed as enlargement of the ventricles with enlargement of the infants head secondary to increased intracranial pressure.
Hydrocephalus
What results due to birth asphyxia?
Hypoxic-ischemic encephalopathy
Caudal regression symptoms and sono:
Occurs most often in children of diabetic mothers and is associated with various other genitourinary, anal, vertebral, and limb anomalies; neurologic impairment; bowel or bladder incontinence may occur in severe cases. Sono: Appearance varies with degree of deformity.
The risk factors for DDH include?
Oligo, breech, first pregnancy, high birth weight, born in cold seasons, swaddling countries, infants with tortocollis. (Cong. anomalies- Spina bifidia, scoliosis, arthrogryposis, and talipes)
What are the two clinical maneuvers?
Ortolani and barlow maneuvers
A premature infant born at 26 weeks gestational age undergoes scanning at 4 weeks of age for routine follow-up to prematurity. The sonogram reveals symmetric regions of increased echogenicity in the watershed area. This would be consistent with?
PVL
A coronal image of the neonatal head demonstrates the lateral ventricles at the level of the third ventricle and forament of Monro. The transducer should be angled in which direction to visualize the glomys of the choroid plexus?
Posterior
Dandy Walker Malformation (DWM) sono findings:
Posterior fossa cyst communicating with fourth ventricle, enlarged cisterna magna, splaying of cerebellar hemispheres with absent or dysplastic vermis; commonly associated with hydrocephalus.
A 6 week old infant with a hx of a "click" on clinical examination is seen for hip sonogram. The alpha angle measures 60 degrees on the right and 55 degrees on the left. This would be consistent with?
Right hip Type II, Left hip type III
A rare disorder resulting from a destructive process in utero that leads to clefts in the vertebral cortex extending from the midline to the calvaria. The clefts are lined with abnormal gray matter.
Schizencephaly
Coronal/Neutral View:
Transducer in coronal plane at the lateral aspect of hip Hip maintained in physiological neutral position-15-20 degrees of flexion. Should demonstrate the midportion of the acetabulum with ilium appearing as a straight line parallel to the transducer The junction of the ilium and triradiate cartilage should be clearly identified and the cartilaginous tip of the labrum should be visualized. The femoral metaphysis is also seen in this plane, which differentiates this view from the Coronal/Flexion view.
In which of the following views does the normal hip display a "U" shape?
Transverse/flexion
Which of the following would meet the criteria of the minimum standard examination?
Transverse/flexion view with stress maneuvers; coronal/neutral view
What is termed as the growth plate that joins the bony acetabulum?
Triradiate cartilage
When scanning to determine the presence of tethered cord, the vertebral level is determined by counting down from the _____ and confirmed by counting up from the _______.
Twelfth rib; L5-S1 junction
Imaging protocol:
Two orthogonal views with one view that included stress views
GRAF Classification: Coronal/Neutral View
Type I-Normal hip would have angle of 60 degrees or more (shows at least 50% of femoral head coverage by acetabulum) Type II-50 to 60 degrees would reflect a physiologic immaturity in infants less than 3 months-would require follow up but no treatment. If older than 3 month treatment would be required Type III-Subluxation with a shallow acetabulum and an angle of less than 50 degrees. Type IV-Dislocated hip that lacks contact between the acetabulum and the femoral head.
Which Graf classification describes an immature hip with an alpha angle of 50 to 60 degrees?
Type II
Filar Cyst AKA:
Ventriculus terminalis
The exam room needs to be?
Warm, just after feeding, with parents, toys
The femoral head is _______ at birth and begins to ossify between _____ and _____ months.
cartilaginous, 2 and 8