A slight widening of the interhemispheric fissure in an infant. Widening of the interhemispheric fissure in an infant: causes, consequences, what to do? Ultrasound signs of expansion of the interhemispheric fissure, lateral ventricles of the brain (

30.06.2020

Neurosonography (NSG) is a term applied to the study of the brain of a young child: a newborn and an infant until the fontanel closes using ultrasound.

Neurosonography, or ultrasound of the child’s brain, can be prescribed by a pediatrician at the maternity hospital or a neurologist at a children’s clinic in the 1st month of life as part of screening. In the future, according to indications, it is carried out on the 3rd month, on the 6th month and until the fontanelle closes.

As a procedure, neurosonography (ultrasound) is one of the safest research methods, but it should be carried out strictly as prescribed by the doctor, because Ultrasonic waves can have a thermal effect on body tissue.

At the moment, no negative consequences from the neurosonography procedure have been identified in children. The examination itself does not take much time and lasts up to 10 minutes, and it is completely painless. Timely neurosonography can save the health and sometimes even the life of a child.

Indications for neurosonography

The reasons for requiring ultrasound scanning in the maternity hospital are varied. The main ones are:

fetal hypoxia;
asphyxia of newborns;
difficult labor (accelerated/prolonged, with the use of obstetric aids);
intrauterine fetal infection;
birth injuries of newborns;
infectious diseases of the mother during pregnancy;
Rhesus conflict;
C-section;
examination of premature newborns;
detection of fetal pathology on ultrasound during pregnancy;
less than 7 points on the Apgar scale in the delivery room;
retraction/protrusion of the fontanelle in newborns;
suspicion of chromosomal pathologies (according to a screening study during pregnancy).

The birth of a child by cesarean section, despite its prevalence, is quite traumatic for the baby. Therefore, children with such a history are required to undergo NSG for early diagnosis of possible pathology

Indications for ultrasound examination within a month:

suspicion of ICP;
congenital Apert syndrome;
with epileptiform activity (NSH is an additional method for diagnosing the head);
signs of strabismus and diagnosis of cerebral palsy;
head circumference is not normal (symptoms of hydrocephalus/dropsy);
hyperactivity syndrome;
injuries to the child's head;
delay in the development of the infant's psychomotor skills;
sepsis;
cerebral ischemia;
infectious diseases (meningitis, encephalitis, etc.);
rickety shape of the body and head;
CNS disorders due to a viral infection;
suspicion of neoplasms (cyst, tumor);
genetic developmental abnormalities;
monitoring the condition of premature babies, etc.

In addition to the main causes, which are serious pathological conditions, NSG is prescribed when a child’s fever lasts for more than a month and has no obvious cause

Preparation and method of conducting the study

Neurosonography does not require preliminary preparation. The baby should not be hungry or thirsty. If the baby falls asleep, there is no need to wake him up; this is even welcome: it is easier to ensure that the head remains still. The results of neurosonography are issued 1-2 minutes after the completion of the ultrasound.

You can take baby milk and a diaper with you to place your newborn baby on the couch. Before the NSG procedure, there is no need to apply creams or ointments to the fontanel area, even if there are indications for this. This worsens the contact of the sensor with the skin and also negatively affects the visualization of the organ being studied.

The procedure is no different from any ultrasound. A newborn or infant is placed on a couch, the place where the skin comes into contact with the sensor is lubricated with a special gel substance, after which the doctor performs neurosonorgraphy.

Access to brain structures with ultrasound is possible through the large fontanelle, thin temple bone, antero- and posterolateral fontanelles, as well as the foramen magnum. In a child born at term, the small lateral fontanelles are closed, but the bone is thin and permeable to ultrasound. Interpretation of neurosonography data is carried out by a qualified physician.

Normal NSG results and interpretation

Interpretation of diagnostic results consists of describing certain structures, their symmetry and echogenicity of tissues. Normally, in a child of any age, the brain structures should be symmetrical, homogeneous, and have appropriate echogenicity. In the neurosonography transcript, the doctor describes:

symmetry of brain structures - symmetrical/asymmetrical;
visualization of grooves and convolutions (must be clearly visualized);
condition, shape and location of the cerebellar structures (tentory);
condition of the medullary falx (thin hyperechoic stripe);
presence/absence of fluid in the interhemispheric fissure (fluid should be absent);
homogeneity/heterogeneity and symmetry/asymmetry of the ventricles;
condition of the cerebellar tentorium (tent);
absence/presence of formations (cyst, tumor, developmental anomaly, change in the structure of the brain matter, hematoma, fluid, etc.);
the state of the vascular bundles (normally they are hyperechoic).

Table with standards for neurosonography indicators from 0 to 3 months:

Options	Norms for newborns	Norms at 3 months
Lateral ventricles of the brain	Anterior horns – 2-4 mm. Occipital horns – 10-15 mm. Body – up to 4 mm.	Anterior horns – up to 4 mm. Occipital horns – up to 15 mm. Body – 2-4 mm.
III ventricle	3-5 mm.	Up to 5 mm.
IV ventricle	Up to 4 mm.	Up to 4 mm.
Interhemispheric fissure	3-4 mm.	3-4 mm.
Large tank	Up to 10 mm.	Up to 6 mm.
Subarachnoid space	Up to 3 mm.	Up to 3 mm.

The structures should not contain inclusions (cyst, tumor, fluid), ischemic foci, hematomas, developmental anomalies, etc. The transcript also contains the dimensions of the described brain structures. At the age of 3 months, the doctor pays more attention to describing those indicators that should normally change.

Pathologies detected using neurosonography

Based on the results of neurosonography, a specialist can identify possible developmental disorders of the baby, as well as pathological processes: neoplasms, hematomas, cysts:

Choroid plexus cyst (does not require intervention, asymptomatic), usually there are several of them. These are small bubble formations containing liquid - liquor. Self-dissolving.
Subependymal cysts. Formations whose contents are liquid. They occur as a result of hemorrhage and can occur pre- and postpartum. Such cysts require observation and, possibly, treatment, since they can increase in size (due to failure to eliminate the causes that caused them, which may be hemorrhage or ischemia).
Arachnoid cyst (arachnoid membrane). They require treatment, observation by a neurologist and control. They can be located anywhere in the arachnoid membrane, can grow, and are cavities containing liquid. Self-resorption does not occur.
Hydrocephalus/dropsy of the brain is a lesion that results in dilatation of the ventricles of the brain, as a result of which fluid accumulates in them. This condition requires treatment, observation, and control of the NSG over the course of the disease.
Ischemic lesions also require mandatory therapy and dynamic control studies using NSG.
Hematomas of brain tissue, hemorrhages into the ventricular space. Diagnosed in premature babies. In full-term infants, this is an alarming symptom and requires mandatory treatment, monitoring and observation.
Hypertension syndrome is, in fact, an increase in intracranial pressure. It is a very alarming sign of a significant shift in the position of any hemisphere, both in premature and full-term babies. This occurs under the influence of foreign formations - cysts, tumors, hematomas. However, in most cases, this syndrome is associated with an excess amount of accumulated fluid (CSF) in the brain space.

If any pathology is detected by ultrasound, you should contact special centers. This will help you get qualified advice, make a correct diagnosis and prescribe the correct treatment regimen for your child.

Keywords : perinatal encephalopathy (PEP) or perinatal damage to the central nervous system (PP CNS), hypertensive-hydrocephalic syndrome (HHS); dilatation of the cerebral ventricles, interhemispheric fissure and subarachnoid spaces, pseudocysts on neurosonography (NSG), muscular dystonia syndrome (MSD), hyperexcitability syndrome, perinatal convulsions.

It turns out... more than 70-80%! Children of the first year of life come for consultation to neurological centers about a non-existent diagnosis - perinatal encephalopathy (PEP):

Child neurology is a relatively new field, but is already going through difficult times. At the moment, many doctors practicing in the field of infant neurology, as well as parents of infants with any changes in the nervous system and mental sphere, find themselves “between two fires.” On the one hand, the school of “Soviet child neurology” is excessive diagnosis and incorrect assessment of functional and physiological changes in the nervous system of a child in the first year of life, combined with long-outdated recommendations for intensive treatment with a variety of medications. On the other hand, there is often an obvious underestimation of existing psychoneurological symptoms, ignorance of general pediatrics and the basics of medical psychology, some therapeutic nihilism and fear of using the potential of modern drug therapy; and as a result - lost time and missed opportunities. At the same time, unfortunately, a certain (and sometimes significant) “formality” and “automaticity” of modern medical technologies lead, at a minimum, to the development of psychological problems in the child and his family members. The concept of “norm” in neurology at the end of the 20th century was sharply narrowed; now it is intensively and not always justifiably expanding. Probably the truth is somewhere in the middle...

According to the perinatal neurology clinic of the NEVRO-MED medical center and other leading medical centers in Moscow (and probably in other places), until now, more 80%!!! children in their first year of life are referred by a pediatrician or neurologist from a district clinic for a consultation regarding non-existent diagnosis - perinatal encephalopathy (PEP):

The diagnosis of “perinatal encephalopathy” (PEP) in Soviet child neurology very vaguely characterized almost any dysfunction (and even structure) of the brain in the perinatal period of a child’s life (from about 7 months of intrauterine development of the child and up to 1 month of life after childbirth), arising as a result pathologies of cerebral blood flow and oxygen deficiency.

Such a diagnosis was usually based on one or more sets of any signs (syndromes) of a probable nervous system disorder, for example, hypertensive-hydrocephalic syndrome (HHS), muscular dystonia syndrome (MDS), hyperexcitability syndrome.

After conducting an appropriate comprehensive examination: clinical examination in combination with analysis of data from additional research methods (ultrasound of the brain - neurosonography) and cerebral circulation (Dopplerography of cerebral vessels), fundus examination and other methods, the percentage of reliable diagnoses of perinatal brain damage (hypoxic, traumatic, toxic-metabolic, infectious) is reduced to 3-4% - this is more than 20 times!

The most bleak thing about these figures is not only a certain reluctance of individual doctors to use the knowledge of modern neurology and conscientious delusion, but also a clearly visible psychological (and not only) comfort in the pursuit of such “overdiagnosis.”

Hypertension-hydrocephalic syndrome (HHS): increased intracranial pressure (ICP) and hydrocephalus

Until now, the diagnosis of “intracranial hypertension” (increased intracranial pressure (ICP)) is one of the most commonly used and “favorite” medical terms among pediatric neurologists and pediatricians, which can explain almost everything! and at any age, complaints from parents.

For example, a child often cries and shudders, sleeps poorly, spits up a lot, eats poorly and gains little weight, eyes widen, walks on tiptoes, his arms and chin tremble, there are convulsions and there is a lag in psycho-speech and motor development: “it’s only his fault - increased intracranial pressure." Isn't that a convenient diagnosis?

Quite often, the main argument for parents is “heavy artillery” - data from instrumental diagnostic methods with mysterious scientific graphs and figures. Methods can be used either completely outdated and uninformative /echoencephalography (ECHO-EG) and rheoencephalography (REG)/, or examinations “from the wrong opera” (EEG), or incorrect, in isolation from clinical manifestations, subjective interpretation of normal variants during neurosonodopplerography or tomography.

Unhappy mothers of such children unwittingly, at the suggestion of doctors (or voluntarily, feeding on their own anxiety and fears), pick up the flag of “intracranial hypertension” and for a long time end up in the system of monitoring and treatment of perinatal encephalopathy.

In fact, intracranial hypertension is a very serious and quite rare neurological and neurosurgical pathology. It accompanies severe neuroinfections and brain injuries, hydrocephalus, cerebrovascular accidents, brain tumors, etc.

Hospitalization is mandatory and urgent!!!

Intracranial hypertension (if it really exists) is not difficult for attentive parents to notice: it is characterized by constant or paroxysmal headaches (usually in the morning), nausea and vomiting not associated with food. The child is often lethargic and sad, is constantly capricious, refuses to eat, he always wants to lie down and cuddle with his mother.

A very serious symptom can be strabismus or difference in pupils, and, of course, disturbances of consciousness. In infants, bulging and tension of the fontanelle, divergence of the sutures between the bones of the skull, as well as excessive growth of the head circumference are very suspicious.

Without a doubt, in such cases the child must be shown to specialists as soon as possible. Quite often, one clinical examination is enough to exclude or preliminarily diagnose this pathology. Sometimes additional research methods are required (fundus examination, neurosonodopplerography, computed tomography or magnetic resonance imaging of the brain)

Of course, expansion of the interhemispheric fissure, cerebral ventricles, subarachnoid and other spaces of the cerebrospinal fluid system on neurosonography (NSG) images or brain tomograms (CT or MRI) cannot serve as evidence of intracranial hypertension. The same applies to cerebral blood flow disorders isolated from the clinic, identified by vascular Dopplerography, and “finger impressions” on a skull x-ray

In addition, there is no connection between intracranial hypertension and translucent vessels on the face and scalp, walking on tiptoes, trembling hands and chin, hyperexcitability, developmental disorders, poor academic performance, nosebleeds, tics, stuttering, bad behavior, etc. and so on.

That’s why, if your baby has been diagnosed with “PEP, intracranial hypertension”, based on “goggle” eyes (Graefe’s symptom, “setting sun”) and walking on tiptoes, then you shouldn’t go crazy in advance. In fact, these reactions may be characteristic of easily excitable young children. They react very emotionally to everything that surrounds them and what happens. Attentive parents will easily notice these connections.

Thus, when diagnosing PEP and increased intracranial pressure, it is naturally best to contact a specialized neurological clinic. This is the only way to be sure of the correct diagnosis and treatment.

It is absolutely unreasonable to begin treatment of this serious pathology on the recommendations of one doctor based on the above “arguments”; in addition, such unreasonable treatment is not at all safe.

Just look at the diuretic drugs that are prescribed to children for a long time, which has an extremely adverse effect on the growing body, causing metabolic disorders.

There is another, no less important aspect of the problem that must be taken into account in this situation. Sometimes medications are necessary and the wrongful refusal of them, based only on the mother’s (and more often than not the father’s) own conviction that medications are harmful, can lead to serious troubles. In addition, if there really is a serious progressive increase in intracranial pressure and the development of hydrocephalus, then often incorrect drug therapy for intracranial hypertension entails the loss of a favorable moment for surgical intervention (shunt surgery) and the development of severe irreversible consequences for the child: hydrocephalus, developmental disorders, blindness , deafness, etc.

Now a few words about the no less “adored” hydrocephalus and hydrocephalic syndrome. In fact, we are talking about a progressive increase in intracranial and intracerebral spaces filled with cerebrospinal fluid (CSF) due to the existing! at that moment of intracranial hypertension. In this case, neurosonograms (NSG) or tomograms reveal dilations of the ventricles of the brain, interhemispheric fissure and other parts of the cerebrospinal fluid system that change over time. Everything depends on the severity and dynamics of the symptoms, and most importantly, on the correct assessment of the relationships between the increase in intracerebral spaces and other neural changes. This can be easily determined by a qualified neurologist. True hydrocephalus, which does require treatment, like intracranial hypertension, is relatively rare. Such children must be observed by neurologists and neurosurgeons at specialized medical centers.

Unfortunately, in ordinary life such an erroneous “diagnosis” occurs in almost every fourth or fifth baby. It turns out that some doctors often incorrectly call a stable (usually slight) increase in the ventricles and other cerebrospinal fluid spaces of the brain hydrocephalus (hydrocephalic syndrome). This does not manifest itself in any way through external signs or complaints and does not require treatment. Moreover, if the child is suspected of having hydrocephalus based on a “large” head, translucent vessels on the face and scalp, etc. - this should not cause panic among parents. The large size of the head in this case plays practically no role. However, the dynamics of head circumference growth is very important. In addition, you need to know that among modern children it is not uncommon to have so-called “tadpoles” whose heads are relatively large for their age (macrocephaly). In most of these cases, infants with large heads show signs of rickets, less often - macrocephaly due to the family constitution. For example, dad or mom, or maybe grandpa has a big head, in a word, it’s a family matter and doesn’t require treatment.

Sometimes, when performing neurosonography, an ultrasound doctor finds pseudocysts in the brain - but this is not a reason to panic at all! Pseudocysts are single round tiny formations (cavities) containing cerebrospinal fluid and located in typical areas of the brain. The reasons for their appearance, as a rule, are not reliably known; they usually disappear by 8-12 months. life. It is important to know that the existence of such cysts in most children is not a risk factor for further neuropsychic development and does not require treatment. However, although quite rare, pseudocysts form at the site of subependymal hemorrhages, or are associated with perinatal cerebral ischemia or intrauterine infection. The number, size, structure and location of cysts provide specialists with very important information, taking into account which, based on a clinical examination, final conclusions are formed.

Description of NSG is not a diagnosis! and not necessarily a reason for treatment.

Most often, NSG data provide indirect and uncertain results, and are taken into account only in conjunction with the results of a clinical examination.

Once again, I remind you of the other extreme: in difficult cases, sometimes there is a clear underestimation on the part of parents (less often, doctors) of the child’s problems, which leads to a complete refusal of the necessary dynamic observation and examination, as a result of which the correct diagnosis is made late, and treatment does not lead to the desired result.

Undoubtedly, therefore, if increased intracranial pressure and hydrocephalus are suspected, diagnosis should be carried out at the highest professional level.

What is muscle tone and why is it so “loved”?

Look at your child’s medical record: is there no such diagnosis as “muscular dystonia”, “hypertension” and “hypotension”? - you probably just didn’t go with your baby to the neurologist’s clinic until he was a year old. This is, of course, a joke. However, the diagnosis of “muscular dystonia” is no less common (and perhaps more common) than hydrocephalic syndrome and increased intracranial pressure.

Changes in muscle tone can be, depending on the severity, either a variant of the norm (most often) or a serious neurological problem (this is much less common).

Briefly about external signs of changes in muscle tone.

Muscular hypotonia characterized by a decrease in resistance to passive movements and an increase in their volume. Spontaneous and voluntary motor activity may be limited; palpation of the muscles is somewhat reminiscent of “jelly or very soft dough.” Pronounced muscle hypotonia can significantly affect the rate of motor development (for more details, see the chapter on movement disorders in children of the first year of life).

Muscular dystonia characterized by a condition where muscle hypotonia alternates with hypertension, as well as a variant of disharmony and asymmetry of muscle tension in individual muscle groups (for example, more in the arms than in the legs, more on the right than on the left, etc.)

At rest, these children may experience some muscle hypotonia during passive movements. When trying to actively perform any movement, during emotional reactions, when the body changes in space, muscle tone increases sharply, pathological tonic reflexes become pronounced. Often, such disorders subsequently lead to improper development of motor skills and orthopedic problems (for example, torticollis, scoliosis).

Muscular hypertension is characterized by increased resistance to passive movements and limitation of spontaneous and voluntary motor activity. Severe muscle hypertension can also significantly affect the rate of motor development.

Violation of muscle tone (muscle tension at rest) can be limited to one limb or one muscle group (obstetric paresis of the arm, traumatic paresis of the leg) - and this is the most noticeable and very alarming sign, forcing parents to immediately consult a neurologist.

It is sometimes quite difficult for even a competent doctor to notice the difference between physiological changes and pathological symptoms in one consultation. The fact is that changes in muscle tone are not only associated with neurological disorders, but also strongly depend on the specific age period and other characteristics of the child’s condition (excited, crying, hungry, drowsy, cold, etc.). Thus, the presence of individual deviations in the characteristics of muscle tone does not always cause concern and require any treatment.

But even if functional disorders of muscle tone are confirmed, there is nothing to worry about. A good neurologist will most likely prescribe massage and physical therapy (exercises on large balls are very effective). Medicines are prescribed extremely rarely.

Hyperexcitability syndrome

(syndrome of increased neuro-reflex excitability)

Frequent crying and whims with or without cause, emotional instability and increased sensitivity to external stimuli, sleep and appetite disturbances, excessive frequent regurgitation, motor restlessness and shuddering, trembling of the chin and arms (etc.), often combined with poor growth weight and bowel dysfunction - do you recognize such a child?

All motor, sensitive and emotional reactions to external stimuli in a hyperexcitable child arise intensely and abruptly, and can fade away just as quickly. Having mastered certain motor skills, children constantly move, change positions, constantly reach for and grab objects. Children usually show a keen interest in their surroundings, but increased emotional lability often makes it difficult for them to communicate with others. They are very impressionable, emotional and vulnerable! They fall asleep extremely poorly, only with their mother, they constantly wake up and cry in their sleep. Many of them have a long-term reaction of fear when communicating with unfamiliar adults with active reactions of protest. Typically, hyperexcitability syndrome is combined with increased mental exhaustion.

The presence of such manifestations in a child is just a reason to contact a neurologist, but in no case is it a reason for parental panic, much less drug treatment.

Constant hyperexcitability is not causally specific and can most often be observed in children with temperamental characteristics (for example, the so-called choleric type of reaction).

Much less frequently, hyperexcitability can be associated and explained by perinatal pathology of the central nervous system. In addition, if a child’s behavior is suddenly disrupted unexpectedly and for a long time for virtually no apparent reason, and he or she develops hyperexcitability, the possibility of developing an adaptation disorder reaction (adaptation to external environmental conditions) due to stress cannot be ruled out. And the sooner the child is examined by specialists, the easier and faster it is possible to cope with the problem.

And, finally, most often, transient hyperexcitability is associated with pediatric problems (rickets, digestive disorders and intestinal colic, hernia, teething, etc.).

There are two extremes in the tactics of monitoring such children. Or an “explanation” of hyperexcitability using “intracranial hypertension” and intense drug treatment often using drugs with serious side effects (diacarb, phenobarbital, etc.). Or complete neglect of the problem, which can subsequently lead to the formation of persistent neurotic disorders (fears, tics, stuttering, anxiety disorders, obsessions, sleep disorders) in the child and his family members, and will require long-term psychological correction.

Of course, it is logical to assume that an adequate approach is somewhere in between...

Separately, I would like to draw the attention of parents to seizures - one of the few disorders of the nervous system that really deserves close attention and serious treatment. Epileptic seizures do not occur often in infancy, but they are sometimes severe, insidious and disguised, and immediate drug therapy is almost always necessary.

Such attacks can be hidden behind any stereotypical and repetitive episodes in the child’s behavior. Incomprehensible shudders, head nods, involuntary eye movements, “freezing,” “squeezing,” “limping,” especially with a fixed gaze and lack of response to external stimuli, should alert parents and force them to turn to specialists. Otherwise, a late diagnosis and untimely prescribed drug therapy significantly reduce the chances of treatment success.

All circumstances of the seizure episode must be accurately and completely remembered and, if possible, recorded on video for further detailed description at the consultation. If convulsions last a long time or are repeated, call “03” and urgently consult a doctor.

At an early age, the child’s condition is extremely changeable, so developmental deviations and other disorders of the nervous system can sometimes be detected only during long-term dynamic monitoring of the baby, with repeated consultations. For this purpose, specific dates for planned consultations with a pediatric neurologist in the first year of life have been determined: usually at 1, 3, 6 and 12 months. It is during these periods that most serious diseases of the nervous system of children in the first year of life can be detected (hydrocephalus, epilepsy, cerebral palsy, metabolic disorders, etc.). Thus, identifying a specific neurological pathology in the early stages of development makes it possible to begin complex therapy on time and achieve the maximum possible result.

And in conclusion, I would like to remind parents: be sensitive and attentive to your kids! First of all, it is your meaningful participation in the lives of children that is the basis for their future well-being. Do not treat them for “supposed illnesses,” but if something worries and concerns you, find the opportunity to get independent advice from a qualified specialist.

Neurosonography (NSG) is a term applied to the study of the brain of a young child: a newborn and an infant until the fontanel closes using ultrasound.

Indications for neurosonography

The reasons for requiring ultrasound scanning in the maternity hospital are varied. The main ones are:

fetal hypoxia;
asphyxia of newborns;
difficult labor (accelerated/prolonged, with the use of obstetric aids);
intrauterine fetal infection;
birth injuries of newborns;
infectious diseases of the mother during pregnancy;
Rhesus conflict;
C-section;
examination of premature newborns;
detection of fetal pathology on ultrasound during pregnancy;
less than 7 points on the Apgar scale in the delivery room;
retraction/protrusion of the fontanelle in newborns;
suspicion of chromosomal pathologies (according to a screening study during pregnancy).

Indications for ultrasound examination within a month:

suspicion of ICP;
congenital Apert syndrome;
with epileptiform activity (NSH is an additional method for diagnosing the head);
signs of strabismus and diagnosis of cerebral palsy;
head circumference is not normal (symptoms of hydrocephalus/dropsy);
hyperactivity syndrome;
injuries to the child's head;
delay in the development of the infant's psychomotor skills;
sepsis;
cerebral ischemia;
infectious diseases (meningitis, encephalitis, etc.);
rickety shape of the body and head;
CNS disorders due to a viral infection;
suspicion of neoplasms (cyst, tumor);
genetic developmental abnormalities;
monitoring the condition of premature babies, etc.

In addition to the main causes, which are serious pathological conditions, NSG is prescribed when a child’s fever lasts for more than a month and has no obvious cause

Preparation and method of conducting the study

Normal NSG results and interpretation

symmetry of brain structures - symmetrical/asymmetrical;
visualization of grooves and convolutions (must be clearly visualized);
condition, shape and location of the cerebellar structures (tentory);
condition of the medullary falx (thin hyperechoic stripe);
presence/absence of fluid in the interhemispheric fissure (fluid should be absent);
homogeneity/heterogeneity and symmetry/asymmetry of the ventricles;
condition of the cerebellar tentorium (tent);
absence/presence of formations (cyst, tumor, developmental anomaly, change in the structure of the brain matter, hematoma, fluid, etc.);
the state of the vascular bundles (normally they are hyperechoic).

Table with standards for neurosonography indicators from 0 to 3 months:

Options	Norms for newborns	Norms at 3 months
Lateral ventricles of the brain	Anterior horns – 2-4 mm. Occipital horns – 10-15 mm. Body – up to 4 mm.	Anterior horns – up to 4 mm. Occipital horns – up to 15 mm. Body – 2-4 mm.
III ventricle	3-5 mm.	Up to 5 mm.
IV ventricle	Up to 4 mm.	Up to 4 mm.
Interhemispheric fissure	3-4 mm.	3-4 mm.
Large tank	Up to 10 mm.	Up to 6 mm.
Subarachnoid space	Up to 3 mm.	Up to 3 mm.

Pathologies detected using neurosonography

Based on the results of neurosonography, a specialist can identify possible developmental disorders of the baby, as well as pathological processes: neoplasms, hematomas, cysts:

Choroid plexus cyst (does not require intervention, asymptomatic), usually there are several of them. These are small bubble formations containing liquid - liquor. Self-dissolving.
Subependymal cysts. Formations whose contents are liquid. They occur as a result of hemorrhage and can occur pre- and postpartum. Such cysts require observation and, possibly, treatment, since they can increase in size (due to failure to eliminate the causes that caused them, which may be hemorrhage or ischemia).
Arachnoid cyst (arachnoid membrane). They require treatment, observation by a neurologist and control. They can be located anywhere in the arachnoid membrane, can grow, and are cavities containing liquid. Self-resorption does not occur.
Hydrocephalus/dropsy of the brain is a lesion that results in dilatation of the ventricles of the brain, as a result of which fluid accumulates in them. This condition requires treatment, observation, and control of the NSG over the course of the disease.
Ischemic lesions also require mandatory therapy and dynamic control studies using NSG.
Hematomas of brain tissue, hemorrhages into the ventricular space. Diagnosed in premature babies. In full-term infants, this is an alarming symptom and requires mandatory treatment, monitoring and observation.
Hypertension syndrome is, in fact, an increase in intracranial pressure. It is a very alarming sign of a significant shift in the position of any hemisphere, both in premature and full-term babies. This occurs under the influence of foreign formations - cysts, tumors, hematomas. However, in most cases, this syndrome is associated with an excess amount of accumulated fluid (CSF) in the brain space.

Post date: 27.10.2011 08:23

Ksyusha

HELLO! MY SON IS 2 MONTHS OLD. DURING BIRTH WAS HYPOXIA. DEVELOPING NORMALLY. BUT THE ULTRASOUND SHOWED A WIDENING OF THE INTERHEMISPHERIC FIGURE OF 0.56 (NORMAL IS UP TO 0.4). NOT DISPLACED. THE REST OF THE INDICATORS ARE NORMAL. HOW DANGEROUS IS THIS?

Post date: 27.10.2011 18:11

Svetlana

My son also had hypoxia during childbirth and a tight entanglement of the umbilical cord around the neck. According to ultrasound, the expansion of the interhemispheric fissure is greater than normal. He grew and developed according to his age. There were minor problems with speech. We worked with a speech therapist. We will soon be seven years old. A calm and smart boy. Very creative. DON'T WORRY, IT'S NOTHING WORRY!

Post date: 27.10.2011 20:26

Papkina E.F.

Ksyusha, a slight widening of the interhemispheric fissure is not dangerous for the development of the child.

Post date: 28.10.2011 02:43

Ksyusha

oh thank you so much! you reassured me. It’s difficult for us to find a good specialist, and we ourselves are not at all competent in matters of medicine. I forgot to say that we still can’t hold our heads up well. Sometimes I’m too lazy to lift it. When it’s lying on my stomach, it lifts well. But It’s bad on the bed and it’s not always upright. Doctors say that I should be able to hold it well at 2 months. Our body size is 41 cm, at birth it was 36. Please comment.

Post date: 28.10.2011 22:17

Papkina E.F.

Ksyusha’s head growth in 2 months is 4 cm, this is normal. Regarding the unsteady holding of the head, it is necessary to regularly, 8-10 times a day, before feeding, lay the child on the stomach on a hard surface. In addition, exercises on an inflatable ball (laying the child down) are useful tummy onto the ball and roll. A course of general tonic massage also strengthens muscle tone well.

Post date: 29.10.2011 01:36

Ksyusha

Thank you again. We will definitely buy the ball and use the rest of the recommendations. Good health to you!

Post date: 15.05.2012 16:14

Julia

please tell me, my son, 4.5 months old, had an ultrasound scan of his head, and we were told that he has a 6mm m/n gap, when the norm is 5mm, what should we do in this situation, we need to treat it somehow... and they also advised us to do a control speakers..thanks for the answer.

Post date: 17.05.2012 22:06

Papkina E.F.

Yulia, if there are no other changes on the ultrasound and in the development of the child, then a slight expansion of the bladder does not pose a danger.

Post date: 31.05.2012 05:51

Tatiana

Hello, we have dilation all the way up to 2.4 mm, we are 2 months old, should we be worried about this?

Post date: 03.06.2012 22:05

Papkina E.F.

Tatyana, this is the norm.

Post date: 06.06.2012 18:34

Guest

Hello! my son is 1.5 months old, in the maternity hospital he had a chin trimmer when he cried, we were injected with magnesium, everything went away. After discharge, 2 weeks later the same thing began, only in a calm state the child’s chin sometimes trembles. At the first examination, the neurologist sent me for an ultrasound. The ultrasound report showed enlargement of the bladder and something else (it’s illegibly written there). The doctor prescribed treatment with asparkam, pantogam and hypothiazide for a month. diagnosing us with intracranial pressure. tell me what enlargement of the bladder is and is pressure dangerous at this age????

Post date: 27.07.2012 10:53

Guest

Hello! My son is 4 months old, enlargement of the bladder is 5.0 mm, diastasis GM/bone D 5.2 S 4.8 mm, third ventricle 3.8 mm. PRB F left 3.4mm right 4.3mm. Diagnosis of enlargement of the bladder, dilation of the prostate gland, enlargement of the 3rd ventricle. Impaired resorption. No treatment was prescribed. Control at 6-7 months. What to do??

Post date: 14.08.2012 10:12

Julia

Good afternoon Our son is 3.5 months old, today we had an ultrasound of the brain, the conclusion indicated that the interhemispheric fissure was widened by 9mm. How can you get rid of this? What procedures are best to undergo? Thank you

Post date: 18.08.2012 19:40

Papkina E.F.

Dear parents! Enlargement of the bladder and 3rd ventricle is a manifestation of previous hypoxia and moderate intracranial hypertension. It is impossible to prescribe treatment without examination; contact a neurologist in person.

Post date: 30.08.2012 09:26

OLGA V.

Hello! My son is 2 months old, they did an ultrasound of the brain, they said that the expansion of the interhemispheric fissure = 10.6 mm and intracranial pressure. At birth, og = 36 cm, and at 2 months = 42.5 cm, while height = 60 cm, and weight = 6065 g We went to a neurologist, he prescribed us to drink Diacarb + Asparkam + Cavinton. Vaccinations were postponed for a month. Ultrasound showed that the ventricles were normal. The pediatrician said that all our height, weight and OG indicators correspond to a 3-month-old child. I would like to add that the birth was very difficult through an emergency caesarean section, there was hepoxia, the baby was born blue, but immediately screamed, on the Apgar scale - 8/9 points. The child was calm from birth, sleeps well at night, only wakes up to eat and then sleep, watches objects , walks, tries to get toys with his hands, holds his head, but really not for long. Please tell me how critical the deviation from the norm of the interhemispheric fissure is in our situation, and whether the doctor prescribed the right treatment for us and whether it is necessary at all? This is my second child, my first Now she’s 7 years old, I looked at her card and at 1 month she was 42 cm, and they didn’t send us anywhere and we didn’t do any neurosonography, unlike the second child, she was restless, and the healthy girl grew up and by the age of one year the fontanel had healed. What should I do in this situation, I ask for your help? Thanks in advance!

Post date: 06.12.2011 11:40

Vika

Hello! Please tell me what these data indicate. Subarachnoid space 2mm. interhemispheric fissure 6mm. Ventricular system, all parameters 3mm. The tank in the sagittal plane is 2.6 mm. Dopplerography: PMA RI 0/54? OA-RI 0.52. Vein of Galena speed 12 cm per second.
Is it worth taking asparkam if you have vitamin D deficiency? THANK YOU IN ADVANCE!

Post date: 06.12.2011 21:29

Papkina E.F.

Vika, expansion of the interhemispheric fissure is a sign of fluid accumulation between the hemispheres of the brain. In such cases, diacarb is usually prescribed to drain excess fluid along with asparkam to prevent the excretion of potassium and magnesium salts, which it contains.
If there is a lack of vitamin D, vitamin D3 or other drugs (Vigontol, fish oil) are prescribed, but asparkam is not needed in this case.

Post date: 12.03.2012 16:42

Guest

Hello! Please explain, we were diagnosed with mild dilactation of the bodies of the lateral ventricles, is this very scary?

Post date: 13.03.2012 21:08

Papkina E.F.

Mild dilatation of the bodies of the lateral ventricles does not require therapy and is not dangerous for the child.

Post date: 04.05.2012 18:02

Irina

Hello. We did an ultrasound of the brain. The ultrasound specialist said that there is some widening of the interhemispheric fissure. We are 4 months old - the width of the interhemispheric fissure is 8mm. What does this mean? very worried

Post date: 05.05.2012 22:14

Papkina E.F.

Irina, isolated widening of the interhemispheric fissure does not threaten anything bad.

Post date: 06.07.2012 11:07

Anastasia

Hello, does the child have a 7mm interhemispheric fissure, should this be treated or can a massage be used?

Post date: 07.07.2012 20:31

Papkina E.F.

Anastasia, if no other pathology is identified and the child is developing normally, then medication treatment is not required.

Post date: 21.08.2012 13:00

Guest

We are 6 months old. The interhemispheric gap is 6mm. Is this dangerous and does it need to be treated somehow? The neurologist said you can drink lingonberries, is that true?

Post date: 23.08.2012 21:59

Papkina E.F.

This is not dangerous if the child develops normally.

Post date: 02.09.2012 22:38

Guest

Good evening! The child had an ultrasound scan of the brain. Ventricular index 31% interhemispheric fissure 7.3 width of the bodies left 20 right 20, depth of the anterior horns left 7.8 right 8.4 width of the posterior horns left 4.8 right 5.4 width of the 3rd ventricle 9.6 blood flow pl Galena 14.8 . Tell me, do you need treatment? The child is developing normally.

Post date: 05.09.2012 22:03

Papkina E.F.

According to ultrasound data, there are manifestations of intracranial hypertension. Contact a neurologist, he will check whether the child’s reflexes and development correspond to his age. If there are deviations, treatment is required.

Post date: 05.09.2012 22:32

Guest

Thank you very much!

Post date: 19.09.2012 11:02

Julia

Good afternoon The child had an ultrasound scan of the brain. We are 9 months old. MP is 8 mm, Anterior horns vs 4.6 vd 4.6 Occipital horns 15.8 and 16.3. third ventricle 4.1 Cystene magna slit-shaped. Subarachnoid space on the right 6.3 on the left 6.3. The speed of blood flow in the vein of Galen is 10.6 (it decreased more). The child is developing well, there are no abnormalities. Decipher it please. They did the ultrasound 8 times. They drank Diacarb, there was a 6*12 tank, it closed and the bladder increased (it was 5mm). They told us to drink Diacarb again. Is this correct, if outwardly we were told everything was fine with him, or the ultrasound is not normal. Thank you in advance

Post date: 24.09.2012 21:29

Papkina E.F.

Yulia, if there are no deviations in the child’s development, then based on the enlargement of the bladder alone, treatment is not indicated.

Post date: 26.09.2012 09:54

Julia

Thank you very much for your answer! Can I have one more question? We noticed that the Subarachoidal space on the right is increased 6.3 on the left 6.3. It does not require treatment. And what does it mean.

Post date: 26.09.2012 19:36

Papkina E.F.

Julia, this means a moderate accumulation of fluid on the outer surface of the brain and between the gyri. Treatment is required only if the child is lagging behind in motor or emotional development.

Post date: 29.09.2012 05:08

Angelica

Hello! My son is 1 year old. Do an ultrasound of the brain today: The structures of the brain are developed according to gestational age. The pattern of convolutions is differentiated. The subarachnoid space is expanded - 6 mm. The interhemispheric fissure is widened -6.2 mm. The cavity of the transparent septum is 3.5. Lateral ventricles: Depth of anterior horns right - 5 left - 5, depth of bodies right -8, left -7, width of occipital horns right -13 left -14. The choroid plexuses of the lateral ventricles are homogeneous. The width of the 3rd ventricle is -3. Depth 4 ventricles -3. Large tank -5. Subcortical ganglia: echogenicity, echostructure on the right and left - b/o, Periventricular region: echogenicity, echostructure on the right and left - b/o. Please tell me what does this all mean? What consequences might there be? What to do in general. Nothing like this is visible in the child; he is developing normally. Very worried. Thank you very much in advance.

Post date: 03.10.2012 21:12

Guzel

Hello! My child is 8 months old. They did an ultrasound of the brain. The interhemispheric fissure is widened to 3-4 mm in all. At 7 months there were febrile convulsions that lasted 4 minutes. and didn't happen again. The doctor prescribed Picamilon, Vintocetin and Cortexin injections. She also prescribed long-term use of Depakine. I read the instructions for the medications and was horrified by the side effects. Is the child’s condition dangerous and is it worth taking these medications? The child is very active and develops normally. Thank you in advance!