Pediatric Brain Sonography Overview
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Questions and Answers

What is one of the primary reasons for scanning a pediatric brain?

  • Assessment of vision problems
  • Follow-up for hydrocephalus (correct)
  • Routine check for developmental milestones
  • Evaluation of pediatric sleep disorders

Which imaging technique is preferred for evaluating the pediatric brain due to its safety?

  • MRI
  • Synography (correct)
  • CT scanning
  • X-ray imaging

What is the typical frequency range of the probe used for pediatric brain scans?

  • 10 to 15 megahertz
  • 1 to 2 megahertz
  • 5 to 10 megahertz (correct)
  • 15 to 20 megahertz

Until what age is the anterior fontanel considered a good acoustic window for brain scanning?

<p>24 months (C)</p> Signup and view all the answers

Which fontanel is best used for evaluating interventricular hemorrhage in infants?

<p>Posterior fontanel (C)</p> Signup and view all the answers

What anatomical structure separates the frontal bones from the parietal bones?

<p>Coronal suture (C)</p> Signup and view all the answers

Why is the use of synography particularly advantageous in pediatric imaging?

<p>It is less expensive and portable. (C)</p> Signup and view all the answers

How long can the fontanels be used as good acoustic windows for brain imaging?

<p>Anterior until 12 months, posterior until 3 months. (D)</p> Signup and view all the answers

What is the typical amount of cerebral spinal fluid produced daily in infants?

<p>140 cc (C)</p> Signup and view all the answers

Which structure is hypoechoic and separates the frontal horns of the lateral ventricles in a fetus?

<p>Caenum septum pellucidum (B)</p> Signup and view all the answers

Where is the caudothomic groove located?

<p>At the junction of the caudate nucleus and the thalami (D)</p> Signup and view all the answers

What is the echogenicity of the caudate nucleus typically described as?

<p>Hyperechoic (A)</p> Signup and view all the answers

Which area is the most common site for germinal matrix hemorrhage?

<p>Caudothomic groove (C)</p> Signup and view all the answers

How does the appearance of the caenum septum pellucidum differ in younger infants compared to older infants?

<p>More cystic (A)</p> Signup and view all the answers

What is a key characteristic observed in older infants regarding sulci and gyri?

<p>More pronounced sulci and gyri (B)</p> Signup and view all the answers

What does a hypervascular endothelial lining in the germinal matrix indicate?

<p>High risk of bleeding (C)</p> Signup and view all the answers

Which part of the lateral ventricles is referred to as the occipital horn?

<p>Posterior horn (A)</p> Signup and view all the answers

What is the function of the choroid plexus in relation to cerebrospinal fluid?

<p>Produces cerebrospinal fluid (D)</p> Signup and view all the answers

In a sagittal view, what is the caudothomic notch also known as?

<p>Caudothomic groove (D)</p> Signup and view all the answers

The appearance of which structure will typically change from cystic to hypoechoic as the infant ages?

<p>Caenum septum pellucidum (C)</p> Signup and view all the answers

What anatomical feature lies inferior to the body of the lateral ventricles?

<p>Caudate nucleus (B)</p> Signup and view all the answers

What is a characteristic feature of the fluid within the lateral ventricles?

<p>Anechoic (C)</p> Signup and view all the answers

What does a grade one hemorrhage signify, and where is it typically located?

<p>It is confined to the germinal matrix area within the caudophthalmic groove. (A)</p> Signup and view all the answers

Which description correctly characterizes the echogenicity of a grade one hemorrhage when it is acute?

<p>Highly echogenic and bright. (A)</p> Signup and view all the answers

What is the primary concern for infants with a grade three or four hemorrhage?

<p>They may develop severe neurological deficiencies. (D)</p> Signup and view all the answers

Where does intraventricular hemorrhage primarily occur in grade two cases?

<p>In the lateral ventricles. (B)</p> Signup and view all the answers

What condition can result from severe intraparenchymal hemorrhage?

<p>Cerebral palsy. (D)</p> Signup and view all the answers

How do clinicians generally scan the neonatal brain for hemorrhages?

<p>By scanning coronal and sagittal views. (C)</p> Signup and view all the answers

What anatomical region is primarily associated with sub-apendymal hemorrhages?

<p>Germinal matrix area. (D)</p> Signup and view all the answers

Which imaging feature indicates that bleeding has progressed to grade two?

<p>Presence of dilated ventricles. (D)</p> Signup and view all the answers

What structure does the inner hemispheric fissure help reference when comparing each hemisphere?

<p>Corpus callosum (B)</p> Signup and view all the answers

In the context of intraparenchymal hemorrhage, which structures would likely reveal echogenicities in grades three and four?

<p>The cerebrum and ventricles. (B)</p> Signup and view all the answers

What might be a common outcome when a grade three or four hemorrhage occurs?

<p>Development of cerebral shunts. (A)</p> Signup and view all the answers

What shape does the silvium fissure resemble at the described level?

<p>A Y turned on its side (D)</p> Signup and view all the answers

What change occurs to the echogenicity of a hemorrhage as it ages past the acute stage?

<p>It transitions to becoming hypo-echoic. (A)</p> Signup and view all the answers

What does a higher presence of hyperchoic areas in the brain indicate about the infant?

<p>The infant is more mature. (D)</p> Signup and view all the answers

Which structure is associated with the lateral ventricles in each hemisphere?

<p>Caudate nucleus (D)</p> Signup and view all the answers

Why is early scanning significant for infants at risk of intracranial hemorrhages?

<p>To assess for the different grades of hemorrhages. (A)</p> Signup and view all the answers

What is indicated if there is fluid present in the ventricles of the brain?

<p>Potential developmental issues (B)</p> Signup and view all the answers

In a moderate to severe intraventricular hemorrhage, how does the bleed typically present in a sonographic view?

<p>As a hypoechoic structure within enlarged ventricles. (B)</p> Signup and view all the answers

What typically happens to the choroid plexus in the presence of a sub-apendymal hemorrhage?

<p>It becomes bright and bulb-like. (B)</p> Signup and view all the answers

Which structure is located midline and is often observed before moving laterally into the hemispheres?

<p>Corpus callosum (B)</p> Signup and view all the answers

What does the term 'lady and the dress' refer to in this anatomical context?

<p>A way to visualize midline structures (D)</p> Signup and view all the answers

How does the appearance of the cavemceptum palucidum change with age?

<p>It becomes less cystic as the infant matures. (A)</p> Signup and view all the answers

Which brain structure is indicated by the black arrow in the midline section?

<p>Thalamus (D)</p> Signup and view all the answers

What could minimal presence of sulci in the brain suggest about the infant?

<p>The infant is younger or premature. (A)</p> Signup and view all the answers

Which part of the brain is located at the posterior extent as described in the passage?

<p>Occipital lobe (B)</p> Signup and view all the answers

What structure pulsates through the silvium fissure?

<p>Middle cerebral artery (A)</p> Signup and view all the answers

What structure connects the parietal bones to the occipital bones?

<p>Lamboid suture (B)</p> Signup and view all the answers

What does the caudothomic groove relate to in terms of brain anatomy?

<p>Position of the lateral ventricles (A)</p> Signup and view all the answers

Which structure lies within the inner hemispheric fissure and separates the two brain hemispheres?

<p>Falc cerebri (A)</p> Signup and view all the answers

Where is the majority of cerebrospinal fluid (CSF) produced?

<p>Choroid plexus (A)</p> Signup and view all the answers

Which ventricle is classified as a midline structure?

<p>Both B and C (C)</p> Signup and view all the answers

What connects the third ventricle to the fourth ventricle?

<p>Aqueduct of Sylvius (C)</p> Signup and view all the answers

What anatomical structure is responsible for the flow of cerebrospinal fluid between the ventricles?

<p>Foramen of Monroe (D)</p> Signup and view all the answers

Which statement accurately describes the anterior fontanel?

<p>It is located between the frontal and parietal bones. (A)</p> Signup and view all the answers

What is the main function of the corpus callosum?

<p>To connect the two hemispheres of the brain (C)</p> Signup and view all the answers

What is the significance of the inner hemispheric fissure?

<p>It is a deep groove that separates the hemispheres. (A)</p> Signup and view all the answers

Which structure is most posterior in the brain?

<p>Occipital lobe (A)</p> Signup and view all the answers

What is the role of the choroid plexus in the brain?

<p>To produce cerebrospinal fluid (B)</p> Signup and view all the answers

Which foramen connects the fourth ventricle to the subarachnoid space?

<p>Foramen of Luschka (C)</p> Signup and view all the answers

In relation to premature infants, how do their lateral ventricles typically appear?

<p>Larger than in term babies (A)</p> Signup and view all the answers

What is the primary function of the cerebral spinal fluid?

<p>To protect the brain from injury (D)</p> Signup and view all the answers

Flashcards

Pediatric brain scans

Scans used to monitor and evaluate the developing brains of infants and children.

Hydrocephalus

A condition where fluid builds up in the brain, potentially causing swelling or damage.

Intracranial hemorrhage

Bleeding within the skull, often a result of head injury or other causes.

Synchrotron imaging (synography)

A fast, noninvasive ultrasound technique used to image a newborn baby's brain.

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Anterior fontanel

A soft spot on a baby's skull, important for brain growth and assessment.

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Posterior fontanel

Soft spot on top of baby's head; observable for a limited time, and assess brain growth/function.

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Coronal suture

A fibrous joint that separates the frontal and parietal bones of the skull.

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Frontal & sagittal sutures

Fibrous joints that form the bony structure of the skull, useful in evaluating some brain conditions.

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What are sutures?

Fibrous joints that connect the bones of the skull.

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Parietal bones

Two bones that form the top and sides of the skull.

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Lambdoid suture

The suture that connects the parietal bones to the occipital bone.

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Occipital bone

The bone at the back of the skull.

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Falx cerebri

A fold of dura mater that separates the two hemispheres of the brain.

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Inner hemispheric fissure

A deep groove that separates the right and left hemispheres of the brain.

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Cerebrum

The largest part of the brain, responsible for higher functions.

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Four lobes of the cerebrum

Frontal, parietal, temporal, and occipital lobes - each responsible for different functions.

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Ventricles of the brain

Spaces in the brain filled with cerebrospinal fluid (CSF) that provide cushioning.

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Lateral ventricles

Two large ventricles located within the hemispheres of the brain.

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Third ventricle

A small ventricle in the midline of the brain.

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Fourth ventricle

A ventricle located at the back of the brain, near the brainstem.

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Foramen of Monroe

A small opening that connects the lateral ventricles to the third ventricle.

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Cerebral Spinal Fluid (CSF) Production

The brain produces approximately 800 cc's of CSF daily, but only around 140 cc's is present in a normal infant.

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Choroid Plexus Appearance

The choroid plexus, which produces CSF, has a hyperechoic appearance on ultrasound, meaning it shows up as bright.

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CSF Appearance

Cerebrospinal fluid (CSF) appears anechoic on ultrasound, meaning it is dark and lacks any internal echoes.

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Lateral Ventricle Parts

The lateral ventricles have different sections: anterior (frontal), occipital, and temporal horns, and the trigone (atria) where the occipital and temporal horns connect.

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Thalami Location

The thalami, important landmarks in the brain, are located inferior to the body of the lateral ventricles.

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Septum Pellucidum

The septum pellucidum is a hypoechoic (dark) structure that separates the frontal horns of the lateral ventricles.

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Septum Pellucidum Closure

The septum pellucidum typically closes by 2-3 months after birth.

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Caudate Nucleus Location & Appearance

The caudate nucleus is located inferior and lateral to the frontal horns of the lateral ventricles, appearing hyperchoic (bright) on ultrasound.

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Thalamus Location & Appearance

The thalamus is located inferior to the body of the lateral ventricles, appearing homogeneous (uniform) on ultrasound.

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Caudothalamic Groove

The caudothalamic groove is the area where the caudate nucleus and thalamus meet, and it is the most common site for a germinal matrix hemorrhage.

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Germinal Matrix

The germinal matrix is a highly vascular region within the caudothalamic groove that is prone to bleeding.

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Germinal Matrix Hemorrhage Location

A germinal matrix hemorrhage is most likely to occur in the caudothalamic groove.

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Septum Pellucidum Appearance in Infants

The septum pellucidum appears more cystic in younger infants, becoming less cystic with age due to closure by 2-3 months postpartum.

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Brain Maturity Indicators

The presence of sulci (grooves) and gyri (ridges) on ultrasound indicates brain maturity, appearing more prominent in older infants.

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Most Posterior Brain Region

The occipital lobe is the most posterior region of the brain, responsible for processing visual information.

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Most Anterior Brain Region

The frontal lobe is located at the front of the brain and is involved in higher-level cognitive functions like planning, decision-making, and personality.

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What is the Inner Hemispheric Fissure?

The inner hemispheric fissure is a deep groove that separates the two hemispheres of the brain.

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Corpus Callosum

The corpus callosum is a thick band of nerve fibers that connects the two hemispheres of the brain, enabling them to communicate.

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Caudate Nucleus

The caudate nucleus is a C-shaped structure located deep within the brain, involved in movement planning, learning, and memory.

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Silvium Fissure

The silvium fissure is a deep groove on the surface of the brain, resembling a 'Y' turned on its side.

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Middle Cerebral Artery

The middle cerebral artery is a major blood vessel that supplies blood to the frontal, parietal, and temporal lobes of the brain.

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Tentorium

The tentorium is a tough, membrane-like structure that separates the cerebellum from the cerebrum.

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Sulci

Sulci are the grooves or folds on the surface of the brain, increasing the surface area for processing information.

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Gyri

Gyri are the ridges or bumps on the surface of the brain, located between the sulci.

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Glomerulus of the Choroid Plexus

The glomerulus of the choroid plexus is a cluster of blood vessels located within the ventricles of the brain, responsible for producing cerebrospinal fluid.

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Subapendymal Hemorrhage (Grade 1)

A subapendymal hemorrhage (grade 1) is a small bleed located in the region near the ventricles of the brain, often associated with premature babies.

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Cavenum Septum Pellucidum

The Cavenum Septum Pellucidum is a thin membrane located between the frontal horns of the lateral ventricles, usually closing as a baby gets older.

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Study Notes

Pediatric Brain Sonography

  • Reasons for Scanning: Follow-up for hydrocephalus, abnormal prenatal diagnoses, and intracranial hemorrhages.
  • Rapid Evaluation: Sonography is a fast, risk-free method for evaluating infants in nurseries.
  • Advantages: Portable, low-cost, no radiation or sedation required.
  • Intracranial Hemorrhages: Sonography is highly sensitive and specific for evaluating these.
  • Probe Frequency: Average is 7.5-8 MHz, but 5-10 MHz probes are also used.

Cranial Fontanels

  • Anterior Fontanel: Soft spot, open until ~2 years old; good acoustic window typically until ~12-14 months.
  • Posterior Fontanel: Open until ~3 months postpartum; useful for visualizing interventricular hemorrhage and ventricular horns.

Cranial Sutures and Bones

  • Frontal Suture: Separates frontal bones.
  • Coronal Suture: Separates frontal and parietal bones.
  • Sagittal Suture: Separates parietal bones.
  • Lambdoid Suture: Connects parietal and occipital bones.

Falx Cerebri

  • Structure: Fibrous structure within the inner hemispheric fissure.
  • Function: Separates the two hemispheres.

Brain Divisions

  • Cerebrum: Upper portion, comprised of four lobes (frontal, parietal, temporal, occipital).
  • Brainstem
  • Cerebellum

Ventricles

  • Function: System of spaces for cerebrospinal fluid (CSF) flow.
  • Lateral Ventricles: Located in each hemisphere.
  • Third Ventricle: Midline structure.
  • Fourth Ventricle: Midline structure.
  • Foramina: Connect ventricles for CSF flow (Foramen of Monro, Aqueduct of Sylvius, Foramen of Luschka).
  • Larger in Premature Infants: Lateral ventricles are often larger in preterm babies and fluid content affects visualization.
  • Choroid Plexus: Site of CSF production (70%).

Cerebral Spinal Fluid (CSF)

  • Production: 800 cc/day produced, but only ~140 cc present in healthy infants.
  • Distribution: From choroid plexus to subarachnoid space.
  • Sonographic Appearance: CSF is anechoic; choroid plexus is hyperechoic.

Additional Brain Structures

  • Corpus Callosum: Deep bridge of nerve fibers connecting hemispheres.
  • Choroid Plexus (continued): Specialized capillaries secrete CSF.
  • Thalami: Homogeneous structures inferior to lateral ventricles.
  • Caudate Nucleus: Hyper-echoic, inferior and lateral to frontal horns.
  • Caudothalamic Groove: Junction of caudate nucleus and thalamus. Frequent site of germinal matrix hemorrhage.
  • Germinal Matrix: Hypervascular endothelial lining (usually not visualized sonographically), but high risk of bleeding.

Intraventricular Hemorrhage (IVH)

  • Grades:
  • Grade 1 (Sub-apendymal): Confined to germinal matrix in caudothalamic groove.
  • Grade 2 (Intraventricular): Clot extends into lateral ventricles.
  • Grade 3-4 (Intraparenchymal): Clot extends beyond ventricles into brain parenchyma.
  • Clinical Significance: Increased intracranial pressure; potential complications like cerebral palsy.

Scanning Protocols

  • Coronal Views: Six images from front to back.
  • Sagittal Views: Five images, from midline to each hemisphere.
  • Midline vs. Lateral: Identify structures based on location (midline or lateral hemisphere).
  • Landmark Use: Use known anatomical landmarks such as corpus callosum, ventricles etc. to guide scanning and interpretation.

Important Considerations

  • Infant Age/Gestational Age: Affects the appearance of structures like the cavum septum pellucidum and sulci-gyri patterns.
  • Visualizing Sulci/Gyri: Their presence/absence helps determine infant maturity.
  • Hyperechoic/Hypoechoic Regions: Recognition of these features is key for correct diagnosis.

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Description

This quiz covers pediatric brain sonography, focusing on its applications such as evaluating hydrocephalus and intracranial hemorrhages. It includes the importance of cranial fontanels and sutures in imaging, emphasizing the advantages of using sonography in infants. Test your understanding of the key concepts and techniques involved in this specialized field.

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