Winter ‘25 Neonatal Neuro/Spine

Cerebrospinal Fluid (CSF)

  • Definition: CSF is a clear fluid found in the brain and spinal cord.

  • Production: Mainly produced by the choroid plexus in the ventricles of the brain.

  • Review structures that produce the majority of CSF.

Sonographic Findings

  • Cerebral Infarction and Edema: Review sonographic findings associated with infarction and cerebral edema.

  • Hydrocephalus: Understand the causes, including:

    • Communicating hydrocephalus: blockage of CSF flow in the subarachnoid space.

    • Non-communicating hydrocephalus: obstruction usually at the ventricular level.

  • Chiari Malformation: Know the most common type and its sonographic findings.

    • Identify Chiari malformations I-IV, focusing on the typical findings for the most common.

  • Aqueductal Stenosis: Review the level of obstruction (between the:

    • Foramina of Monro

    • Lateral and third ventricle

    • Third and fourth ventricle).

Malformations and Anomalies

  • Cloacal Malformation: Recall how this appears in terms of brain structure, especially with occipital horns and frontal horns.

  • TORCH Infections: Know what TORCH stands for and identify the most common infections from this group without the need to memorize scientific names for bacteria.

    • Commonly seen on ultrasound in cases of TORCH infections.

  • Holoprosencephaly: Understand the different types (alobar, semilobar, lobar) and their ultrasound findings, including features related to alobar type.

    • Types predict severity and brain structure division.

  • Hydranencephaly: Review definitions and causing factors.

Hemorrhages

  • Review various types of hemorrhages and their sonographic findings, including:

    • Subependymal Hemorrhage (also known as Germinal Matrix Hemorrhage)

    • Intraventricular Hemorrhage

    • Intraparencymal Hemorrhage

  • Understand the grading of hemorrhages (grade 1 to grade 3).

  • Identify areas where hemorrhages typically begin, like the caudothalamic groove.

  • Note that less than 32 weeks gestation may require specific ultrasound timing for evaluating hemorrhage (1-3 days, 5-7 days, 10-14 days).

Cystic Lesions

  • Identify the most common cystic lesion in the brain: types include:

    • Arachnoid Cyst

    • Choroid Plexus Cyst

    • Subependymal Cyst

    • Posterior Fossa Cyst.

  • Differentiate between epidural and subdural hematoma by location of blood accumulation.

Additional Findings

  • Periventricular Leukomalacia: Review the definition and ultrasound appearance.

  • Lissencephaly: Definitions and sonographic findings.

  • Spine Ultrasound: Expect questions on basic spinal ultrasound findings – remember caudal medullaris ending location (below L3 or above).

  • Review different types of spinal pathologies like caudal regression, tethered cord, diastematomyelia.

  • Understand the significance of the corpus callosum and its anatomical location, along with its function in the brain.

  • Be prepared to recognize schizencephaly and Dandy-Walker malformation through definitions and sonographic findings.

  • Review ventricular system's role in CSF circulation, tracing the path from choroid plexus through the foramen of Monro, into the third ventricle, continuing through the Cerebral Aqueduct, and exiting at the foramen of Magendie or foramen of Lushka.