Marwan Alhalabi MD PhD Professor in Reproductive Medicine Faculty of Medicine Damascus University & Clinical Medical Director Orient Hospital Assisted Reproduction Center Damascus, Syria.
MarwanAlhalabiMDPhDProfessorinReproductiveMedicineFacultyofMedicineDamascusUniversity&ClinicalMedicalDirectorOrientHospitalAssistedReproductionCenterDamascus,Syria.
Thehumanbrainisthemostcomplex
massofprotoplasmonearth-perhapseveninourgalaxy.
•
6
BrainDevelopment
• The spinalcorddevelopsfromthecaudal2/3 oftheneuraltube
Caudal portion
Rostral portion
mesencephalon
metencephalon
myelencephalon
6 weeks4 weeks
• Pinealgland:sleep-wakecycle,secretesmelatonin.
• Epithalamus:masticatoryandswallowingfunctions.
• Thalamus:majorrelayofsensoryinputtocerebralcortex.
Diencephalon
2
Microcephaly
Anencephaly
Chiari0Malforma3on
Chiari MalformationChiari MalformationClinical IssuesClinical Issues AFP,AFP, High morbidity &mortalityHigh morbidity &mortality 4%aneuploidy rate4%aneuploidy rate CS at delivery termCS at delivery term 80% need ventriculoperitoneal 80% need ventriculoperitoneal
shuntshunt Can reverse with in utero surgeryCan reverse with in utero surgery Preventive threatment with folic Preventive threatment with folic
acidacid
Imaging FindingsImaging Findings Posterior fossa Posterior fossa „„banana banana
signsign““ Calvarial lemon signCalvarial lemon sign VentruculomegalyVentruculomegaly CM obliterationCM obliteration Head normal or smallHead normal or small
Diagnostic ChecklistDiagnostic Checklist AmniocentesisAmniocentesis Cranial findings easier to Cranial findings easier to
see than ONTDsee than ONTD Compressed CM may be Compressed CM may be
only finding!!only finding!!
14 +4 weeks
Hydrocephalus , T 21Hydrocephalus , T 21Ventriculomegaly
HydrancephalyHydrancephaly
Hydranecphaly
Encephalocele
Occipital EncephaloceleOccipital EncephaloceleImaging FindingsImaging Findings Herniated brain tissueHerniated brain tissue „„cyst within the cystcyst within the cyst““ Ventriculomegaly 70Ventriculomegaly 70--
80%80% Microcephaly 25%Microcephaly 25% PolyhydramniosPolyhydramnios OligohydramniosOligohydramnios
CAVE:CAVE: Associated with multiple Associated with multiple
syndroms ( Meckelsyndroms ( Meckel-- Gruber )Gruber )
HoloprosencephalyHoloprosencephaly
Pilu
Holoprosencephaly
Hemimegalencephaly Arachnoid0cyst
ACC
SOP
SchizencephalySchizencephalySchizencephaly
PFAFluidACyst
Yong seok et al.
Vascular0Malforma3ons
Circle of Willis MallformationCircle of Willis Mallformation
Sunday, July 28, 13
Sonography&of&the&CNS
Basic0Examination “Neurosongram”
Sunday, July 28, 13
Planes0of0Basic0Examina3on
Axial0Planes Sagibal0Planes
Sunday, July 28, 13
Axial0Planes
Sunday, July 28, 13
Axial0Planesa:0Transventricular
Sunday, July 28, 13
Axial0Planesa:0Transventricular
b:0Transthalamic0
Sunday, July 28, 13
Axial0Planesa:0Transventricular
C:0Transcerebeller0
b:0Transthalamic0
Sunday, July 28, 13
The0Transventricular0plane
Sunday, July 28, 13
The0Transventricular0plane
Frontal0hones
Sunday, July 28, 13
The0Transventricular0plane
Frontal0hones
Atrium
Sunday, July 28, 13
The0Transthalamic00Plane
Sunday, July 28, 13
T
T
The0Transcerebeller00plane
Sunday, July 28, 13
Cavum0Sep30Pellucidi
T
T
The0Transcerebeller00plane
Sunday, July 28, 13
Cavum0Sep30Pellucidi
Frontal0hones
T
T
The0Transcerebeller00plane
Sunday, July 28, 13
Sagibal0Planes00
Sunday, July 28, 13
Sagibal0Planes00
A:0The0Midsagittal0Plan
Sunday, July 28, 13
Sagibal0Planes00
b:0Parasgittal0plane
A:0The0Midsagittal0Plan
Sunday, July 28, 13
28
Corpus0Callosum
Lateral0Ventricles
Third0Ventricle
midbrainPituitary
Splenium
Thalamus
hypothalamus
Fourth0ventricle
The0Corpus0Callosum
Sunday, July 28, 13
29
ParaHSagiGal&Plane&
Sunday, July 28, 13
30
Basic Examniation ChecklistBasic Examniation Checklist
Head + NeckHead + NeckMidline & FalxMidline & FalxCavum septi pellucidiCavum septi pellucidiLateral cerebral ventriclsLateral cerebral ventriclsChoroid PlexusChoroid PlexusCerebellumCerebellumCisterna magnaCisterna magna
Sunday, July 28, 13
• Head&Neck
• Midline&Falx
• Cavum septi pellucidi
• Lateralcerebralventricles
• Choroidplexus
• Cerebellum
• Cisternamagna
32
Microcephaly
Anencephaly
Chiari0Malforma3on
Chiari MalformationChiari MalformationClinical IssuesClinical Issues AFP,AFP, High morbidity &mortalityHigh morbidity &mortality 4%aneuploidy rate4%aneuploidy rate CS at delivery termCS at delivery term 80% need ventriculoperitoneal 80% need ventriculoperitoneal
shuntshunt Can reverse with in utero surgeryCan reverse with in utero surgery Preventive threatment with folic Preventive threatment with folic
acidacid
Imaging FindingsImaging Findings Posterior fossa Posterior fossa „„banana banana
signsign““ Calvarial lemon signCalvarial lemon sign VentruculomegalyVentruculomegaly CM obliterationCM obliteration Head normal or smallHead normal or small
Diagnostic ChecklistDiagnostic Checklist AmniocentesisAmniocentesis Cranial findings easier to Cranial findings easier to
see than ONTDsee than ONTD Compressed CM may be Compressed CM may be
only finding!!only finding!!
14 +4 weeks
Hydrocephalus , T 21Hydrocephalus , T 21Ventriculomegaly
HydrancephalyHydrancephaly
Hydranecphaly
Encephalocele
Occipital EncephaloceleOccipital EncephaloceleImaging FindingsImaging Findings Herniated brain tissueHerniated brain tissue „„cyst within the cystcyst within the cyst““ Ventriculomegaly 70Ventriculomegaly 70--
80%80% Microcephaly 25%Microcephaly 25% PolyhydramniosPolyhydramnios OligohydramniosOligohydramnios
CAVE:CAVE: Associated with multiple Associated with multiple
syndroms ( Meckelsyndroms ( Meckel-- Gruber )Gruber )
HoloprosencephalyHoloprosencephaly
Pilu
Holoprosencephaly
Hemimegalencephaly Arachnoid0cyst
ACC
SOP
SchizencephalySchizencephalySchizencephaly
PFAFluidACyst
Yong seok et al.
Vascular0Malforma3ons
Circle of Willis MallformationCircle of Willis Mallformation
Sunday, July 28, 13
(<#10#mm#is#normal).##Independent#of#gesta7onal#age#
Mild&10&–&15&mmLow&Risk&
Severe&>&15&mm&High&Risk&
mean#=#6:8#mm
Ventriculomegaly0(hydrocephalus)
Sunday, July 28, 13
•Square0Shaped,0Interrupts0and0Fills0The0Space0Between0The0Frontal0Horns•The0CSP:0Becomes0Visible0At01600Weeks,0Obliterate0Near0Term
Absent0CSP
Sunday, July 28, 13
Blake’s&pouch&cyst Megacisterna&magna DHW&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
Findings Upward0rotation0of0an0intact0vermis0with0normal0torcular
Cisterna0magna0>10mm0with0intact0and0normally0positioned0cerebellum
Upward0rotation0of0the0vermis0(normal0or0hypoplastic)0with
elevated0torcular
SagiGal&
Axial
Categoriza3on0of0posterior0fossa0fluid0collec3ons0(1)
Sunday, July 28, 13
78