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Radiology
Intracranial Hemorrhage, Cysts, Tumors, and Destructive Lesions
Built from Obstetric Imaging
What’s inside
8 sections · 142 slides
Overview
- What this topic is about
- Malformation or destruction - two different stories
- The three usual causes of brain destruction
- The six conditions covered here
- Three destructive lesions side by side
- How to read that picture
Intracranial hemorrhage
Blood inside the fetal head: where it collects, how it looks, and what it leaves behind
- Bleeding inside the fetal head
- Names you will see for the same problem
- When it usually turns up
- Two families of bleed
- Which bleeds are hard to see
- 40%
- Common after birth, rare before it
- Causes from the mother and the pregnancy
- Causes inside the fetus
- When the fetal platelets are destroyed
- Fetal alloimmune thrombocytopenia
- Where the bleeding starts
- What a massive bleed sets off
- Following that chain in words
- Grading the bleed by severity
- Grades I and II - blood stays put
- Grades III and IV - the ventricle gives way
- Blood in the ventricle without swelling
- What to notice in a grade II bleed
- A ventricle filled with clot and enlarged
- What to notice in a grade III bleed
- Bleeding that has destroyed brain tissue
- What to notice in a grade IV bleed
- Bleeding at the back of the head
- Blood in the layer outside the brain
- Blood outside the brain pushing the midline across
- What to notice in this subdural bleed
- A crescent of blood over the hemisphere
- Fresh versus advanced subdural blood
- What the ultrasound shows overall
- The two classic ultrasound signs
- The clot changes over weeks - four phases
- How long each phase lasts
- Adding Doppler to the picture
- Bleed or tumour? Watch it over time
- Other reasons a ventricle looks wide
- What can be done before birth
- 14.6%
- Reading those outcome numbers
- Bleeding that comes back next pregnancy
- Key points on intracranial hemorrhage
Porencephaly
A cavity carved out of one hemisphere after a stroke in the womb
- A hole in the brain matter
- How a stroke before birth carves a cavity
- Other recognised causes
- What the pathologist sees
- Porencephaly on the scan
- Porencephaly or schizencephaly?
- Using MRI to settle the question
- Porencephaly or arachnoid cyst?
- What is offered to the parents
- What happens to these children
- Key points on porencephaly
Hydranencephaly
The cerebral hemispheres gone, replaced by a bag of fluid
- The hemispheres are simply not there
- 1 : 10,000
- Vascular and ischaemic causes
- Toxic, infectious and twin causes
- The routes that end in hydranencephaly
- Hydranencephaly on the scan
- Timing of the destruction
- Three look-alikes to exclude
- Tests and choices before birth
- What families need to be told
- Key points on hydranencephaly
Schizencephaly
Full-thickness clefts lined with grey matter - a migration problem, not a demolition
- A slit that runs right through the brain wall
- Not destruction - a wiring detour
- The COL4A1 connection
- Three features the pathologist looks for
- The company schizencephaly keeps
- The classic two-type split
- The newer three-type scheme
- Reading the newer scheme
- Schizencephaly on the scan
- What else can look like this
- Counselling and outcome
- Risk in the next pregnancy
- Key points on schizencephaly
Intracranial cysts
Fluid-filled bubbles in and around the fetal brain - usually benign, occasionally not
- A bubble of fluid in the head
- Three places a cyst can sit
- Reading that classification
- Two cysts that matter in the fetus
- Names for the glioependymal cyst
- How common are they
- The three coverings of the brain
- Where an arachnoid cyst forms
- Primary or secondary cyst
- Where arachnoid cysts like to sit
- 73%
- Reading those association figures
- Glioependymal cysts and their partner problem
- Fluid-filled cysts in four places in the fetal brain
- What to notice across those four cysts
- The scan features and classic signs
- Telling cysts from other fluid collections
- Three more look-alikes
- What to do before birth
- The good news about isolated cysts
- When delivery plans change
- Key points on intracranial cysts
Intracranial tumors
Rare fetal brain masses that all look alike on ultrasound and mostly do badly
- What grows inside the fetal head
- The families of fetal brain tumour
- Tumours that travel with a syndrome
- 1.7
- Why a fetus grows a tumour
- 70%
- Teratoma - the commonest one
- Astrocytoma - second in line
- A benign glial tumour with a name to remember
- Three more tumour types
- Craniopharyngioma - benign but not harmless
- Genetic conditions and their tumours
- Reading that table
- Lipomas and the corpus callosum
- What often travels with a fetal brain tumour
- Tumours on ultrasound
- Three fetal brain tumours that look alike
- What to notice across those three tumours
- Teratoma growing out through the face and skull
- Why the outgrowth matters
- The classic sign, and the hardest call
- What can be offered
- The complications that threaten mother and fetus
- 7%
- Reading the survival figures
- Key points on intracranial tumors
Pulling it together
What separates these lesions, and what they share
- Sorting the lesions by what you see
- Three habits that keep you right
- What the referring physician needs to know
- Suggested readings
- References
- References (continued)
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- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition