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165 Cards in this Set

  • Front
  • Back

The meninges of the brain comprise?

1. Pia mater- Innermost (known as “soft mother.”


2. Arachnoid mater- middle layer [filled with CSF is between this layer and pia mater]


3. Dura Mater-outermost


Double layer membrane, known as “rough mother.” Forms strongest barrier.

The ventricular system includes?

Lateral ventricles: frontal horns, central body, temporal horns, occipital horns.

What is the trigone?


Of the lateral ventricle, are they equal in size?

The site where the body, occipital, temporal horns join together is the atrium of lateral ventricle (trigone).


Left is larger than the right.

What are the acoustic windows to evaluating the neonatal brain?

Anterior fontanel - most common


Posterior fontanel: Eval for any critical neonate on ECMO, clot in occipital.


Mastoid fontanel: Eval cerebellum posterior fossa.

What are the acoustic windows to evaluating the neonatal brain?

Anterior fontanel - most common


Posterior fontanel: Eval for any critical neonate on ECMO, clot in occipital.


Mastoid fontanel: Eval cerebellum posterior fossa.

What is tentorium cerebelli?

Extension of falx cerebri and separates the cerebellum from the cerebrum.

A Rare variant can occur at the formen of monro, what is this?

Coarctation of the ventricle- cyst in coronal view at the superior and lateral ventricle often at the level of foramen of Monro (Intraventricular foramen). Eval to make sure it’s not a hemorrhage. Either dilation or subependymal cyst.

A Rare variant can occur at the formen of monro, what is this?

Coarctation of the ventricle- cyst in coronal view at the superior and lateral ventricle often at the level of foramen of Monro (Intraventricular foramen). Eval to make sure it’s not a hemorrhage. Either dilation or subependymal cyst.

Production of the majority of of CSF? What also produce CSF?

Choroid plexus.


Ventricular apendyma, intracranial subarachnoid lining, and spinal subarachnoid lining.

A Rare variant can occur at the formen of monro, what is this?

Coarctation of the ventricle- cyst in coronal view at the superior and lateral ventricle often at the level of foramen of Monro (Intraventricular foramen). Eval to make sure it’s not a hemorrhage. Either dilation or subependymal cyst.

Production of the majority of of CSF? What also produce CSF?

Choroid plexus.


Ventricular apendyma, intracranial subarachnoid lining, and spinal subarachnoid lining.

What connects the two cerebral hemispheres?


What is the largest and densest bundle of white matter?

Corpus callosum.


Corpus callosum.

What are the lobes of the brain?

Frontal, parietal, occipital, temporal.

This called smooth brain appearance; groove or depression on the surface of the brain separating the gyri?

Sulcis

This called smooth brain appearance; groove or depression on the surface of the brain separating the gyri?

Sulcis

Gyri and Sulcis develop the same time?

Gyri is identified around 32 weeks. Right side more advanced.


Sulci identified around 26 weeks.

How does the CSF flow from lateral ventricles?

Lateral ventricles ➡️ Foramen of Monro ➡️ Third ventricle ➡️ Aqueduct of Sylvius ➡️ fourth ventricle ➡️ lateral foramen of luschka or foramen Magendie ➡️ cisterna magna and basal subarachnoid cisterns.

Subarachnoid- who’s the largest?

Cisterna Magna.

Subarachnoid- who’s the largest?

Cisterna Magna.

Where is the MCA located?

Sylvian Fissure

Subarachnoid- who’s the largest?

Cisterna Magna.

Where is the MCA located?

Sylvian Fissure

Where’s the sylvian fissure located?

Most lateral aspect of the brain

Subarachnoid- who’s the largest?

Cisterna Magna.

Where is the MCA located?

Sylvian Fissure

Where’s the sylvian fissure located?

Most lateral aspect of the brain

Identify Corpus callosum parts:

Genom, body, splenium “posterior,” rostrum.

Subarachnoid- who’s the largest?

Cisterna Magna.

Where is the MCA located?

Sylvian Fissure

Where’s the sylvian fissure located?

Most lateral aspect of the brain

Identify Corpus callosum parts:

Genom, body, splenium “posterior,” rostrum.

Basal ganglia includes?

Caudate nucleus, lentiform nucleus, claustrum, thalamus.

Brain stem includes?

Midbrain, pons, medulla oblongata.

Cerebellum Hemispheres are connected by?

Vermis

Cerebrovascular system includes?

Internal cerebral arteries, vertebral arteries, circle of Willis.

Cerebrovascular system includes?

Internal cerebral arteries, vertebral arteries, circle of Willis.

Explain the functions of each lobe?

Frontal: emotions, intellect, personality, morality, speech.


Parietal lobe: pain, temperature, spatial ability.


Occipital: vision


Temporal: auditory, olfactory


Other: judgment, memory, reasoning.

Cerebrovascular system includes?

Internal cerebral arteries, vertebral arteries, circle of Willis.

Explain the functions of each lobe?

Frontal: emotions, intellect, personality, morality, speech.


Parietal lobe: pain, temperature, spatial ability.


Occipital: vision


Temporal: auditory, olfactory


Other: judgment, memory, reasoning.

What’s the posterior fossa below the tentorium cerebelli?

Cerebellum.

What’s the common site for bleeding in a full term neonate?

Glomus

What’s the common site for bleeding in a full term neonate?

Glomus

Common site for hemorrhage in preterm infant less that 34 weeks gestation?

Caudothalmic groove

What’s the common site for bleeding in a full term neonate?

Glomus

Common site for hemorrhage in preterm infant less that 34 weeks gestation?

Caudothalmic groove (germinal matrix)

Where’s the location of the most white matter?

Periventricular area

What’s the common site for bleeding in a full term neonate?

Glomus

Common site for hemorrhage in preterm infant less that 34 weeks gestation?

Caudothalmic groove

Where’s the location of the most white matter?


What window used to identify this?

Periventricular area; posterior fontanel.

What is a watershed zone?


Echogenicity the same as choroid plexus?

Premature infants have terminal ends of the vessel bed and may be used to describe periventricular white matter.


Echogenicity should not be greater than choroid plexus. if it is, suspect hemorrhage or infarction.

Sagittal on anterior fontanel, what do you see to the right and left?

Right: occipital portion of the brain.


Left: anterior brain.

Sagittal on anterior fontanel, what do you see to the right and left?

Right: occipital portion of the brain.


Left: anterior brain.

This is considered a fifth brain lobe. Remains open until 24-26 week gestation?

Insula

We use a certain window to evaluate cerebellar hemorrhages, congenital anomalies of third and fourth ventricles.

Mastoid fontanel

Mastoid fontanel-


notch pointing up vertical position is what plane?


Notch turned right in horizontal plane is what plane?


In the mastoid fontanel you can Eval what major dx?

Coronal plane


Transverse/ axial plane


Hydrocephalus (Ventriculomegaly)

Mastoid fontanel-


notch pointing up vertical position is what plane?


Notch turned right in horizontal plane is what plane?


In the mastoid fontanel you can Eval what major dx?

Coronal plane


Transverse/ axial plane


Hydrocephalus (Ventriculomegaly)

Coronal plane, what do you see anterior?

Orbits, anterior horns, lateral ventricles

Coronal plane- mid of the brain what do you visualize?

Lateral ventricles,CSP, third ventricle-foramen of Monro Corpus Callosum

Coronal plane- mid of the brain what do you visualize?

Lateral ventricles,CSP, third ventricle-foramen of Monro Corpus Callosum

Coronal plane- posterior, what do you visualize?

Ambient wings and cisterna magna, choroids, glomerus of choroid, occipital lobe

Ventricular measurements: GO

1. Ventricular Index measured at widest point to falx.


2. Anterior Horn Width measures at a diagonal at the widest point.


3. Thalamo-occipital distance (parasagittal view) measure from outermost part of the occipital horn to junction of choroid with the outermost part of thalamus.

Ventricular measurements: GO

1. Ventricular Index measured at widest point to falx.


2. Anterior Horn Width measures at a diagonal at the widest point.


3. Thalamo-occipital distance (parasagittal view) measure from outermost part of the occipital horn to junction of choroid with the outermost part of thalamus.

Most common metric used for ventricular measurements?


AHW indicates dilation when?


Preterm TOD or Term infant TOD?

Ventricular index.


AHW- over 4mm May indicates dilation.


Preterm TOD > 19 mm


Term infant > 21 mm indicate ventricular dilation.

What’s the largest component of the human CNS; main portion of the brain?

Cerebrum

This has three holes on the floor of the ventricle that opens to subarachnoid space for passage of CSF?

Foramen of Luschka and foramen Magendie

What’s the second largest portion of the brain?

Cerebellum

Sagittal plane: What is superior to Cavum Septum Pellucidi?

Corpus Callosum

Sagittal plane: What is superior to Cavum Septum Pellucidi?

Corpus Callosum

Sagittal plane: what is anterior to corpus callosum?

Anterior cerebral arteries

Sagittal plane: What is superior to Cavum Septum Pellucidi?

Corpus Callosum

Sagittal plane: what is anterior to corpus callosum?

Anterior cerebral arteries

Sagittal plane: inferior to CSP is?


What is the small, gray matter mass located in the third ventricle?

Third ventricle.


When present, moderately echogenic, homogenous: Mass Intermedia.

This is between the thalamus and head of caudate nucleus?

Caudothalmic groove. Marks the arc of germinal matrix.

This is between the thalamus and head of caudate nucleus?

Caudothalmic groove. Marks the arc of germinal matrix.

High susceptible to hemorrhage in premature infant?

Germinal matrix

Evaluation of the pericallosal artery is through which sono window? What variables prove something is wrong?

Anterior fontanel.


If a reversal flow already exists, indication of elevated ICP and fontanel pressure not recommended.


If no flow in pericallosal artery, apply pressure; if reversal flow in diastole, indicated ICP- no measurement needed.

For a pericallosal artery, a RI changing by _____ indicate ICP?

> 0.1 above baseline.

You visualize widening of lateral and third ventricles with a normal size fourth ventricle, what’s the finding?

Aqueducts stenosis

This is considered benign and a link to autism spectrum disorder? Sono appearance: cortical vessels are seen passing via superficial fluid, also known as?


Vessels along the periphery are?

Extra axial fluid.


Cerebral cortical coin sign.


Subdural collection

Most common; premature at risk?

Intracranial hemorrhage (germinal matrix- Intraventricular hemorrhage) aka Subependymal hemorrhage: affects 40-70%.

Most common; premature at risk?

Intracranial hemorrhage (germinal matrix- Intraventricular hemorrhage) aka Subependymal hemorrhage: affects 40-70%.

Intracranial hemorrhages, explain the grading?

Grade 1: SEH w/o ventricular enlargement. (Capillary bleeding in germinal matrix)


Grade 2: IVH w/o ventricular enlargement


Grade 3: IVH with ventricular enlargement


Grade 4: parenchymal hemorrhage

Most common; premature at risk?

Intracranial hemorrhage (germinal matrix- Intraventricular hemorrhage) aka Subependymal hemorrhage: affects 40-70%.

Intracranial hemorrhages, explain the grading?

Grade 1: SEH w/o ventricular enlargement. (Capillary bleeding in germinal matrix)


Grade 2: IVH w/o ventricular enlargement


Grade 3: IVH with ventricular enlargement


Grade 4: parenchymal hemorrhage

Explain the classic grade 4 for intraparenchymal hemorrhage?

Clot extending from the white matter into the ventricular cavity.

Most common; premature at risk?

Intracranial hemorrhage (germinal matrix- Intraventricular hemorrhage) aka Subependymal hemorrhage: affects 40-70%.

Intracranial hemorrhages, explain the grading?

Grade 1: SEH w/o ventricular enlargement. (Capillary bleeding in germinal matrix)


Grade 2: IVH w/o ventricular enlargement


Grade 3: IVH with ventricular enlargement


Grade 4: parenchymal hemorrhage

Explain the classic grade 4 for intraparenchymal hemorrhage?

Clot extending from the white matter into the ventricular cavity.

Intracerebellar hemorrhages are located?


What sono window to obtain image?

Area of germinal matrix located around fourth ventricle.


Coronal view of mastoid (cerebellar area)

Most common; premature at risk?

Intracranial hemorrhage (germinal matrix- Intraventricular hemorrhage) aka Subependymal hemorrhage: affects 40-70%.

Intracranial hemorrhages, explain the grading?

Grade 1: SEH w/o ventricular enlargement. (Capillary bleeding in germinal matrix)


Grade 2: IVH w/o ventricular enlargement


Grade 3: IVH with ventricular enlargement


Grade 4: parenchymal hemorrhage

Explain the classic grade 4 for intraparenchymal hemorrhage?

Clot extending from the white matter into the ventricular cavity.

Intracerebellar hemorrhages are located?


What sono window to obtain image?

Area of germinal matrix located around fourth ventricle.


Coronal view of mastoid (cerebellar area)

Sono finding: zones of increased echogenicity in white matter?

Intraparenchymal hemorrhage

Most common; premature at risk?

Intracranial hemorrhage (germinal matrix- Intraventricular hemorrhage) aka Subependymal hemorrhage: affects 40-70%.

Intracranial hemorrhages, explain the grading?

Grade 1: SEH w/o ventricular enlargement. (Capillary bleeding in germinal matrix)


Grade 2: IVH w/o ventricular enlargement


Grade 3: IVH with ventricular enlargement


Grade 4: parenchymal hemorrhage

Explain the classic grade 4 for intraparenchymal hemorrhage?

Clot extending from the white matter into the ventricular cavity.

Intracerebellar hemorrhages are located?


What sono window to obtain image?

Area of germinal matrix located around fourth ventricle.


Coronal view of mastoid (cerebellar area)

Sono finding: zones of increased echogenicity in white matter?

Intraparenchymal hemorrhage

Hypoxia ischemic injury lesions are better evaluated by what modality?

Mri

Most common; premature at risk?

Intracranial hemorrhage (germinal matrix- Intraventricular hemorrhage) aka Subependymal hemorrhage: affects 40-70%.

Intracranial hemorrhages, explain the grading?

Grade 1: SEH w/o ventricular enlargement. (Capillary bleeding in germinal matrix)


Grade 2: IVH w/o ventricular enlargement


Grade 3: IVH with ventricular enlargement


Grade 4: parenchymal hemorrhage

Explain the classic grade 4 for intraparenchymal hemorrhage?

Clot extending from the white matter into the ventricular cavity.

Intracerebellar hemorrhages are located?


What sono window to obtain image?

Area of germinal matrix located around fourth ventricle.


Coronal view of mastoid (cerebellar area)

Sono finding: zones of increased echogenicity in white matter?

Intraparenchymal hemorrhage

Hypoxia ischemic injury lesions are better evaluated by what modality?

Mri

White matter loss leads to?

White matter volume loss or PVL

To detect early hypoxia or ischemia; Hypoxic- Ischemic Injury lesions, Doppler what structure?


What’s the normal RI? What’s abnormal?


What are some findings of HII?

Anterior cerebral artery (normal RI- 0.70), low < 0.6.


Findings of HII- Fluctuating RI, hyperemia.

To detect early hypoxia or ischemia; Hypoxic- Ischemic Injury lesions, Doppler what structure?

Anterior cerebral artery (normal RI- 0.70), low < 0.6.


Findings of HII- Fluctuating RI, hyperemia.

This is multi focal white matter necrosis; associate with cerebral palsy. Located in the lateral wall of the atria and occipital horns?

Periventricular Leukomalacia

To detect early hypoxia or ischemia; Hypoxic- Ischemic Injury lesions, Doppler what structure?

Anterior cerebral artery (normal RI- 0.70), low < 0.6.


Findings of HII- Fluctuating RI, hyperemia.

This is multi focal white matter necrosis; associate with cerebral palsy. Located in the lateral wall of the atria and occipital horns?

Periventricular Leukomalacia

Infant has normal or small head circumference, enlarged subarachnoid space, widened interhemispheric fissure and persistent ventricular dilation, what this indicate?

Brain atrophy

Porencephaly means?


Multicystic encephalomalacia means?


Hydranencephaly means?

Porencephaly- single cavity


Multicystic enceph= multiple cavities.


Hydranencephaly: large single cavity with entire absence of cerebral hemispheres.

Porencephaly means?


Multicystic encephalomalacia means?


Hydranencephaly means?

Porencephaly- single cavity


Multicystic enceph= multiple cavities.


Hydranencephaly: large single cavity with entire absence of cerebral hemispheres.

This is seen in neonates with Hypoxia ischemic injury lesions and appears linear echogenic foci in thalamus and basal ganglia. Assoc with chromosomal abnormalities, congenital infection, prematurity. Isolated is good prognosis.

LSV- Lentriculostriate Vasculopsthy

Porencephaly means?


Multicystic encephalomalacia means?


Hydranencephaly means?

Porencephaly- single cavity


Multicystic enceph= multiple cavities.


Hydranencephaly: large single cavity with entire absence of cerebral hemispheres.

This is seen in neonates with Hypoxia ischemic injury lesions and appears linear echogenic foci in thalamus and basal ganglia. Assoc with chromosomal abnormalities, congenital infection, prematurity. Isolated is good prognosis.

LSV- Lentriculostriate Vasculopsthy

80-90% infants with myelomenignocele have?


This is considered 50% of all cerebral malformation. Associated with myelocele and myelomenigocele?

Arnold Chianti malformation.

Porencephaly means?


Multicystic encephalomalacia means?


Hydranencephaly means?

Porencephaly- single cavity


Multicystic enceph= multiple cavities.


Hydranencephaly: large single cavity with entire absence of cerebral hemispheres.

This is seen in neonates with Hypoxia ischemic injury lesions and appears linear echogenic foci in thalamus and basal ganglia. Assoc with chromosomal abnormalities, congenital infection, prematurity. Isolated is good prognosis.

LSV- Lentriculostriate Vasculopsthy

80-90% infants with myelomenignocele have?


This is considered 50% of all cerebral malformation. Associated with myelocele and myelomenigocele?

Arnold Chianti malformation.

Cingulate sulcus randomized or spiraled pericallosal artery - abnormal course or absent 3rd ventricle might be where CSP sits, CSP absent. Tear drop enlarged occipital horn “bat wing” appearance?

Agenesis of Corpus Callosum

Porencephaly means?


Multicystic encephalomalacia means?


Hydranencephaly means?

Porencephaly- single cavity


Multicystic enceph= multiple cavities.


Hydranencephaly: large single cavity with entire absence of cerebral hemispheres.

This is seen in neonates with Hypoxia ischemic injury lesions and appears linear echogenic foci in thalamus and basal ganglia. Assoc with chromosomal abnormalities, congenital infection, prematurity. Isolated is good prognosis.

LSV- Lentriculostriate Vasculopsthy

80-90% infants with myelomenignocele have?


This is considered 50% of all cerebral malformation. Associated with myelocele and myelomenigocele?

Arnold Chianti malformation.

Cingulate sulcus randomized or spiraled pericallosal artery - abnormal course or absent 3rd ventricle might be where CSP sits, CSP absent. Tear drop enlarged occipital horn “bar wing” appearance?

Agenesis of Corpus Callosum

Genus, splenium, and rostrum are absent?

Partial agenesis of corpus callosum

Porencephaly means?


Multicystic encephalomalacia means?


Hydranencephaly means?

Porencephaly- single cavity


Multicystic enceph= multiple cavities.


Hydranencephaly: large single cavity with entire absence of cerebral hemispheres.

This is seen in neonates with Hypoxia ischemic injury lesions and appears linear echogenic foci in thalamus and basal ganglia. Assoc with chromosomal abnormalities, congenital infection, prematurity. Isolated is good prognosis.

LSV- Lentriculostriate Vasculopsthy

80-90% infants with myelomenignocele have?


This is considered 50% of all cerebral malformation. Associated with myelocele and myelomenigocele?

Arnold Chianti malformation.

Cingulate sulcus randomized or spiraled pericallosal artery - abnormal course or absent 3rd ventricle might be where CSP sits, CSP absent. Tear drop enlarged occipital horn “bar wing” appearance?

Agenesis of Corpus Callosum

Genus, splenium, and rostrum are absent?

Partial agenesis of corpus callosum

Disruption of 4th ventricle and cerebellar vermis. Huge 4th ventricle cyst occupies where the cerebellum lies. Posterior fossa enlarged with elevation of tentorium cerebelli. Corpus callosum might be absent.

Dandy walker malformation

4th ventricle slightly dilated but communicative with the cyst. Posterior fossa not enlarged, cerebral hemispheres normal, finding is?

Dandy walker variant

4th ventricle slightly dilated but communicative with the cyst. Posterior fossa not enlarged, cerebral hemispheres normal, finding is?

Dandy walker variant

Mega cisterna magna abnormal?

Normal variant

4th ventricle slightly dilated but communicative with the cyst. Posterior fossa not enlarged, cerebral hemispheres normal, finding is?

Dandy walker variant

Mega cisterna magna abnormal?

Normal variant

Ischemia lesion, result of bilateral internal carotid artery occlusion?

Hydranencephaly

This is a cyst filled with CSF that communicates with ventricular system of subarachnoid space. Finding?

Porencephalic cyst

This is a cyst filled with CSF that communicates with ventricular system of subarachnoid space. Finding?

Porencephalic cyst

Choroid plexus cyst is associated to trisomy 18 when?

Choroid plexus cysts are 4-7 mm, unilateral, left larger than the right. If > 10mm and multiple then assoc with trisomy 18.

This is a vascular malformation that occurs in the quadrigeminal cistern. It’s fed by anterior or posterior cerebral artery circulation.

Vein of Galen (Galenic Venous Malformation)

This finding is located in Supra/infratentorial in the posterior fossa with a normal vermis and 4th ventricle. Rise from suprasellar region or quadrimenial plate cistern. Use color Doppler to verify they are not venous malformation.

Arachnoid cysts

This finding is located in Supra/infratentorial in the posterior fossa with a normal vermis and 4th ventricle. Rise from suprasellar region or quadrimenial plate cistern. Use color Doppler to verify they are not venous malformation.

Arachnoid cysts

What’s the most common congenital infection?


2nd most common?

Cytomegalovirus.


Taxoplasmosis

This finding is located in Supra/infratentorial in the posterior fossa with a normal vermis and 4th ventricle. Rise from suprasellar region or quadrimenial plate cistern. Use color Doppler to verify they are not venous malformation.

Arachnoid cysts

What’s the most common congenital infection?


2nd most common?

Cytomegalovirus.


Taxoplasmosis

This is highly associTed with neonate brain infection. Other complication that may rise is hydrocephalus, abscess, white matter softening.

Lentriculostriate vasculopathy

This finding is located in Supra/infratentorial in the posterior fossa with a normal vermis and 4th ventricle. Rise from suprasellar region or quadrimenial plate cistern. Use color Doppler to verify they are not venous malformation.

Arachnoid cysts

What’s the most common congenital infection?


2nd most common?

Cytomegalovirus.


Taxoplasmosis

This is highly associTed with neonate brain infection. Other complication that may rise is hydrocephalus, abscess, white matter softening.

Lentriculostriate vasculopathy

Parenchyma calcifications, finding?

TORCH (congenital infections)

This finding is located in Supra/infratentorial in the posterior fossa with a normal vermis and 4th ventricle. Rise from suprasellar region or quadrimenial plate cistern. Use color Doppler to verify they are not venous malformation.

Arachnoid cysts

What’s the most common congenital infection?


2nd most common?

Cytomegalovirus.


Taxoplasmosis

This is highly associTed with neonate brain infection. Other complication that may rise is hydrocephalus, abscess, white matter softening.

Lentriculostriate vasculopathy

Parenchyma calcifications, finding?

TORCH (congenital infections)

Common complication of infected meninges in a newborn. Hematogenous spread of the infect you choroid plexus. Ventriculoperitoneal shunt May provide persistent infection of the ventricular cavities. Finding?

Ventriculitis

This finding is located in Supra/infratentorial in the posterior fossa with a normal vermis and 4th ventricle. Rise from suprasellar region or quadrimenial plate cistern. Use color Doppler to verify they are not venous malformation.

Arachnoid cysts

What’s the most common congenital infection?


2nd most common?

Cytomegalovirus.


Taxoplasmosis

This is highly associTed with neonate brain infection. Other complication that may rise is hydrocephalus, abscess, white matter softening.

Lentriculostriate vasculopathy

Parenchyma calcifications, finding?

TORCH (congenital infections)

Common complication of infected meninges in a newborn. Hematogenous spread of the infect you choroid plexus. Ventriculoperitoneal shunt May provide persistent infection of the ventricular cavities. Finding?

Ventriculitis

This is more common and occurs earlier than ventriculitis. Inflamed lining became thick, hyperechoic. Finding?


What does this develop from?

Ependymitis; develop from Intraventricular hemorrhage.