Vld vls norm in 1 month. Ultrasound examination of the brain of newborn children (normal anatomy)

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

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

As a procedure, neurosonography (ultrasound) is one of the safest research methods, but it should be carried out strictly according to the doctor's prescription, because. ultrasonic waves can have a thermal effect on body tissues.

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

Indications for neurosonography

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

• fetal hypoxia;
• asphyxia of newborns;
• difficult childbirth (accelerated / prolonged, with the use of obstetric aids);
• intrauterine infection of the fetus;
• birth trauma of newborns;
• infectious diseases of the mother during the gestation period;
• Rhesus conflict;
• C-section;
• examination of premature newborns;
• ultrasound detection of fetal pathology during pregnancy;
• less than 7 points on the Apgar scale in the delivery room;
• retraction / protrusion of the fontanel in newborns;
• suspected chromosomal pathology (according to the screening study during pregnancy).

Indications for ultrasound examination within a month:

• suspicion of ICP;
• congenital Apert syndrome;
• with epileptiform activity (NSG is an additional method for diagnosing the head);
• signs of strabismus and the diagnosis of cerebral palsy;
• the girth of the head does not correspond to the norm (symptoms of hydrocephalus / dropsy of the brain);
• hyperactivity syndrome;
• injuries in the head of the child;
• lag in the development of the infant's psychomotor;
• 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 anomalies of development;
• monitoring the condition of premature babies, etc.

Preparation and method of conducting the study

Neurosonography does not require any preliminary preparation. The baby should not be hungry, thirsty. If the baby fell asleep, it is not necessary to wake him up, this is even welcome: it is easier to ensure the immobility of the head. The results of neurosonography are issued 1-2 minutes after the completion of the ultrasound.

You can take milk for the baby, a diaper with you to put the newborn baby on the couch. Before the NSG procedure, it is not necessary 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 under study.

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

Access to the structures of the brain during ultrasound is possible through the large fontanelle, the thin bone of the temple, the anterior and posterolateral fontanelles, as well as the large occipital foramen. In a child born at term, small lateral fontanelles are closed, but the bone is thin and permeable to ultrasound. The interpretation of neurosonography data is carried out by a qualified doctor.

Normal NSG results and interpretation

Deciphering the diagnostic results consists in describing certain structures, their symmetry and tissue echogenicity. Normally, in a child of any age, the structures of the brain should be symmetrical, homogeneous, corresponding to echogenicity. In deciphering neurosonography, the doctor describes:

• symmetry of brain structures - symmetrical / asymmetric;
• visualization of furrows and convolutions (should be clearly visualized);
• condition, shape and location of the cerebellar structures (natata);
• state of the cerebral crescent (thin hyperechoic strip);
• the presence / absence of fluid in the interhemispheric fissure (there should be no fluid);
• homogeneity/heterogeneity and symmetry/asymmetry of the ventricles;
• the state of the cerebellar plaque (tent);
• absence / presence of formations (cyst, tumor, developmental anomaly, change in the structure of the medulla, hematoma, fluid, etc.);
• the state of the vascular bundles (normally they are hyperechoic).

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

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

Pathologies detected by neurosonography

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

1. Choroid plexus cyst (do not require intervention, asymptomatic), usually there are several. These are small bubble formations in which there is a liquid - cerebrospinal fluid. Self-absorbable.
2. Subependymal cysts. Formations containing liquid. Occur due to hemorrhage, can be pre- and postpartum. Such cysts require observation and possibly treatment, as they may increase in size (due to the failure to eliminate the causes that caused them, which may be hemorrhage or ischemia).
3. Arachnoid cyst (arachnoid membrane). They require treatment, observation by a neurologist and control. They can be located anywhere in the arachnoid membrane, they can grow, they are cavities containing liquid. Self-absorption does not occur.
4. Hydrocephalus / dropsy of the brain - a lesion, as a result of which there is an expansion of the ventricles of the brain, as a result of which fluid accumulates in them. This condition requires treatment, observation, control of NSG over the course of the disease.
5. Ischemic lesions also require mandatory therapy and control studies in dynamics with the help of NSG.
6. Hematomas of the brain tissue, hemorrhages in the space of the ventricles. Diagnosed in premature babies. In full-term - this is an alarming symptom, require mandatory treatment, control and observation.
7. 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 in 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 (liquor) in the space of the brain.

If any pathology is detected during ultrasound, it is worth contacting special centers. This will help to get qualified advice, make a correct diagnosis and prescribe the correct treatment regimen for the child.

• brain encephalopathy

  Due to some circumstances and difficult childbirth, from the moment the baby was born, I worry about not overlooking some deviations in him. I know that, for example, brain encephalopathy is very difficult to diagnose in babies. Mine is almost 5 months now. Sometimes I notice that the child does not fall asleep well and is naughty for a long time before going to bed. and sometimes for a long time he cannot focus on any subject. What examination would you recommend to undergo to rule out encephalopathy, thank you!

• hyperactive child

  What to do with a hyperactive child? Doctor, please advise what to do, I no longer have the strength to deal with a third child. The birth was difficult, almost immediately after the second pregnancy. The third child was born prematurely, but now he has more or less gained weight. And now he is almost a year old, not a minute of literally rest. He crawls, howls, if I don’t look at him or don’t work with him, he starts screaming, crying, banging his head on the floor ((They did soothing baths, massage, everything helps for a while. Such hyperactivity - is there a reason to prescribe special treatment? And you can can home methods do? thank you very much

The owners of the patent RU 2424004:

The invention relates to medicine, namely to pediatric neurology and physiotherapy, and can be used in the treatment of perinatal brain damage of hypoxic-ischemic origin in children of the first year of life. A course of exposure to galvanic current is carried out, while the bifurcated anode is placed on the eye sockets, the cathode is placed on the projection of the sixth-seventh cervical vertebrae and a current of 0.15-0.25 mA is applied. The method contributes to the normalization of the state of liquor-containing spaces, has no contraindications and complications. 6 tab.

The invention relates to medicine, namely to pediatric neurology and physiotherapy, and can be used in the treatment of perinatal brain damage of hypoxic-ischemic origin in children of the first year of life.

Physiotherapeutic methods are the most promising in the treatment of children in the first year of life, since with the correct individual appointment they do not lead to the development of complications, are highly effective and allow you to reduce the number of drugs or completely abandon drug therapy.

A known method for the treatment of perinatal brain damage of hypoxic-ischemic genesis in children of the first year of life, including conducting drug electrophoresis according to the method of A.Yu. Ratner (Ratner A.Yu. Neurology of newborns. - Publishing house of Kazan University, 1995. - 368 p.). Electrophoresis is most often carried out with aminophylline on the cervical spine transversely. The anode is placed at the level of the second-seventh cervical vertebrae, the cathode - at the level of the upper edge of the sternum. Electrophoresis is carried out at low current - up to 0.5 mA. The duration of exposure, depending on age, is 8-10 minutes. The course of treatment is 8-10 procedures performed daily.

However, the method has virtually no effect on the severity of CSF disorders according to neurosonographic studies. The use of eufillin in children with hypertensive-hydrocephalic syndrome, which occurs in 30-70% of children with perinatal brain damage, is not indicated due to the fact that eufillin is a non-selective vasodilator, reduces peripheral resistance and adversely changes the state of cerebral hemodynamics and liquorodynamics. In addition, eufillin belongs to antiplatelet agents, and in children with perinatal brain damage, platelet pathology and a tendency to increased bleeding are often detected. Thus, the use of aminophylline can provoke hemorrhages.

The technical result achieved by the invention is to eliminate liquorodynamic disorders, as well as to reduce contraindications and complications.

The essence of the invention lies in the achievement of the claimed technical result in a method for the treatment of perinatal brain damage of hypoxic-ischemic genesis in children of the first year of life, including a course of exposure to low-strength galvanic current, according to which a bifurcated anode is placed on the eye sockets, the cathode is placed on the projection of the sixth-seventh cervical vertebrae and act with a current of 0.15-0.25 mA.

The clinical studies conducted by the authors showed that the use of a galvanic current of 0.15-0.25 mA according to the orbital-occipital technique in children of the first year of life with perinatal brain damage of hypoxic-ischemic origin leads to the normalization of the state of the CSF-containing spaces, which was confirmed by neurosonographic data. studies, reducing the severity and frequency of complaints and clinical manifestations of this pathology. The galvanization procedure is well tolerated by children, has no side effects and contraindications.

The method is carried out, for example, as follows.

The galvanization procedure is carried out from the apparatus "Elfor-prof" (firm Nevoton, St. Petersburg). The bifurcated anode is placed on the eye sockets, the cathode - on the projection of the sixth-seventh cervical vertebrae. The current strength is 0.15-0.25 mA. The duration of exposure, depending on age, is 8-10 minutes. The course of treatment consists of eight to ten procedures performed daily.

The method is illustrated by the following clinical examples.

1. Girl D.T. was admitted to the Department of Physiotherapy at the age of 4 months 20 days with a diagnosis of perinatal brain damage of hypoxic-ischemic origin, moderate form, hypertension-hydrocephalic syndrome, psychomotor retardation, vegetative-visceral syndrome, syndrome of motor disorders. Concomitant disease: intestinal dysbiosis with overgrowth of Staphylococcus aureus.

Anamnesis: she was born from the second pregnancy (the first one ended with a medical abortion for a period of 7 weeks without complications). Pregnancy proceeded against the background of late mild toxicosis. Childbirth at 36 weeks. Childbirth is fast. The first period of labor is 3 hours, the second period of labor is 45 minutes. Body weight at birth 2490 g, height 49 cm, head circumference 32 cm Apgar score - 7/8 points. The period of adaptation without features. Neurological symptoms began to appear from 1 month of age. There were complaints about poor night and daytime sleep, frequent regurgitation, meteorological dependence, and a tendency to constipation. Examination revealed increased pyramidal muscle tone, hyperreflexia with expansion of reflexogenic zones, marbling of the skin.

Neurological status

Complaints: restless daytime and nighttime sleep (he falls asleep for a long time, wakes up to 6-10 times a night). The severity of this complaint (3 points). Expressed tremor of the arms and chin with anxiety (2 points). Parents also complain of rare but profuse regurgitation (2 points). Parents note a clear connection between sleep disturbance and behavior when weather conditions change (3 points), anxiety during the day almost daily (2 points). The girl suffers from constipation.

Objective examination: head circumference 43 cm (+11 cm in 4 months 20 days). Large fontanel 2.0/2.0 cm, dense edges. Divergence of the sagittal suture. The head is hydrocephalic in shape: frontal tubercles are pronounced, the back of the head hangs down. Expanded venous network on the scalp. Severe marbling of the skin, distal hyperhidrosis. Graefe's symptom is constantly at rest. Neurological examination revealed a moderate increase in pyramidal muscle tone and hyperreflexia with expansion of reflexogenic zones. Delay in the formation of motor skills (does not roll over, uncertainly holds the head in an upright position).

Thus, based on the examination data, the following syndromes of perinatal brain damage of hypoxic-ischemic genesis were established: hypertensive-hydrocephalic syndrome (3 points), delayed psychomotor development (2 points), vegetative-visceral syndrome (3 points), motor violations (2 points).

A neurosonographic study was performed, which was assessed according to the following parameters: the size of the lateral ventricles of the brain on the right and left - Vls=14 mm, Vld=15 mm, the size of the third ventricle of the brain - Vt=3 mm, the indices of the bodies of the lateral ventricles on the right and left - ITBZhl=0 .25, ITBZHp=0.27, the size of the interhemispheric fissure - MPSch=5/14 mm, bone-marrow diastasis=5.5 mm. Minor changes in the architectonics of the brain of posthypoxic genesis. Dilatation of the left ventricle, moderate expansion of the subarachnoid space. Violation of liquorodynamics by hyporesorptive type.

Physiotherapy treatment: Girl D.T. received 10 sessions of galvanization by the orbital-occipital technique. Current strength 0.15 mA, procedure time 8 minutes. Tolerability of procedures is satisfactory. From drug therapy, the girl received pantogam for 1 month at the age dosage.

The results of the examination at the age of the child 6 months 3 days

Complaints: improvement of night sleep (wakes up 1-2 times a night). Daytime sleep normalized. Complaint about sleep disturbance - 1 point. There are no complaints about tremor and regurgitation. Parents noted that the girl's sleep and behavior were much less likely to be disturbed when weather conditions changed, so the complaint about meteosensitivity was 1 point. Parents noted that their daughter had stopped constipation after the end of physiotherapy.

On neurological examination: head circumference 45 cm (+2 cm in 2 months), large fontanel 1.5/1.5 cm, no divergence of the skull sutures. Graefe's symptom (-). Mild marbling of the skin remains. There is no distal hyperhidrosis. Muscle tone is satisfactory. Tendon reflexes are normal. Psychomotor development by age.

Neurosonography: Vls=13 mm, Vld=13 mm, Vt=3 mm, ITBZhl=0.23, ITBZhn=0.23, MPS can be traced at a small distance, bone-marrow diastasis=3 mm. Echoarchitectonics of the brain is not disturbed. There are no violations of liquorodynamics.

Diagnosis: perinatal brain damage of hypoxic-ischemic origin: vegetative-visceral syndrome (1 point).

Examined at 1 year old. There are no complaints.

Neurological examination: Satisfactory condition. Physiological muscle tone. Tendon reflexes are normal. Psychomotor development by age.

Neurosonography: Vls=14 mm, Vld=14 mm, Vt=3 mm, ITBZhl=0.24, ITBZhn=0.24, MPS can be traced at a small distance, bone-marrow diastasis=3 mm. Echoarchitectonics of the brain is not disturbed. There are no violations of liquorodynamics.

Healthy. No further treatment is needed.

2. Boy D.K. entered the department of physiotherapy at the age of 10 months 11 days with a diagnosis of perinatal brain damage of hypoxic-ischemic genesis, moderate form, hypertension-hydrocephalic syndrome, vegetative-visceral syndrome, syndrome of movement disorders. Concomitant disease: right-sided mounting torticollis, JVP, hepatomegaly.

Anamnesis: was born from the first pregnancy. Pregnancy proceeded against the background of early mild toxicosis, acute respiratory viral infections for a period of 24 weeks. Delivery at 40 weeks. Emergency caesarean section due to breech presentation. Birth weight 3400 g, height 51 cm, head circumference 34 cm Apgar score - 8/9 points. The period of adaptation without features. Neurological symptoms began to appear from the age of 6 months, when the parents first noted a pronounced emotional lability in the child, superficial night sleep. The child received drug therapy (Cavinton) for 1 month. After a month of therapy, the complaints are the same.

Neurological status

Complaints: restless night sleep (he falls asleep for a long time, wakes up up to 8 times a night). The severity of this complaint is 3 points. Anxiety during the day daily (3 points).

Objective examination: head circumference 46 cm (+12 cm in 10 months 11 days, +3 cm in 2 months). The big spring is closed. The head is hydrocephalic in shape: frontal tubercles are pronounced. Expanded venous network on the scalp. Moderately pronounced marbling of the skin, distal hyperhidrosis. Neurological examination revealed a moderate increase in pyramidal muscle tone and hyperreflexia with expansion of reflexogenic zones. Head tilt to the right.

Thus, based on the examination data, the following syndromes of perinatal brain damage of hypoxic-ischemic genesis were established: hypertensive-hydrocephalic syndrome (2 points), vegetative-visceral syndrome (1 point), movement disorders syndrome (2 points). Concomitant diseases: Right-sided mounting torticollis, hepatomegaly.

Neurosonography: Vls=13.3 mm, Vld=14.4 mm, Vt=2 mm, ITBVl=0.21, ITBZhn=0.23, MPV=4.7/15 mm, bone-marrow diastasis=2 mm. Slight residual changes in the architectonics of the brain of posthypoxic origin. Moderate expansion of the subarachnoid space. Slight violation of liquorodynamics by hyporesorptive type.

Physical Therapy: Boy D.K. received 10 sessions of galvanization by the orbital-occipital technique. Current strength 0.25 mA, procedure time 10 minutes. Tolerability of procedures is satisfactory. He did not receive medical therapy.

The results of the examination of a child at the age of 1 year.

Complaints: normalization of night sleep. There are no complaints about anxiety during the day.

On neurological examination: head circumference 47 cm (+1 cm in 2 months), large fontanel closed. Graefe's symptom (-). Muscle tone is diffusely reduced. Plano-valgus deformity of the feet. Torticollis is not noted. Tendon reflexes are normal. Psychomotor development by age.

Neurosonography: Vls=14.2 mm, Vld=14.6 mm, Vt=1.8 mm, ITBZhl=0.22, ITBZhn=0.22, MPS can be traced at a small distance, bone-marrow diastasis=2 mm . Normalization of liquorodynamic processes.

Perinatal brain damage of hypoxic-ischemic origin, syndrome of movement disorders (muscle hypotension) - 1 point.

In the future, orthopedic observation is required for diffuse muscle hypotension.

To confirm the effectiveness of the claimed method, 35 children with perinatal brain damage aged from 1 to 11 months were under observation.

All children underwent a full range of clinical examination, analysis of anamnesis data, as well as an examination by a neuropathologist, pediatrician, orthopedist, ophthalmologist. The assessment of the severity of complaints and the clinical condition of children was carried out according to a point system (Zhitomirskaya M.L. Features of the diagnosis and course of intranatal intraventricular hemorrhages in children of the first year of life with hereditary hemostasiopathies. - St. Petersburg, 2001). The state of the brain structures was examined by ultrasonography (standard technique and transcranial ultrasonography). Researches were carried out on devices ACUSON - 128 (USA); TOSHIBA 140 (Japan) complete with sector sensors (3.5 MHz, 5 MHz and 7.5 MHz) and linear sensor (5 and 7 MHz). For a dynamic assessment of the size of the cerebral ventricles and the state of liquorodynamics, neurosonographic indicators were used: ventricular index, the size of the lateral ventricles, the third ventricle of the brain, and bone-marrow diastasis, the size of the interhemispheric fissure.

As a result of a neurological examination, the following syndromes of perinatal brain damage were revealed: movement disorder syndrome (SDR), vegetative-visceral syndrome (VVS), psychomotor developmental delay syndrome (MPMR), hypertensive-hydrocephalic syndrome (HHS).

The children were divided into two groups. The first (main) group (20 children) received treatment according to the claimed method against the background of drug therapy. The second (control) group (15 children) received eufillin electrophoresis on the cervical spine transversely according to the Ratner method against the background of drug therapy. Drug therapy included vasoactive drugs (mainly cavinton), drugs containing hydrolysates of amino acids, neuropeptides that improve the functional state of neurons (actovegin, cortexin), GABAergic drugs (piracetam, pantogam, phenibut), diuretics (diacarb, diuretic herbs) , amino acids (glycine), vitamins of group B (vitamin B1, B6, complex drug "Neuromultivit").

Evaluation of the effectiveness of treatment in groups was carried out by comparing the dynamics of complaints, the severity of neurological syndromes, general condition, neurosonographic parameters before and after treatment. An examination after the fifth procedure was carried out to identify possible side effects of the treatment, and the individual tolerance of the factor was assessed. To assess the dynamics of the child's condition during treatment, a second examination by a neuropathologist and a pediatrician, neurosonographic study was carried out a month after the end of treatment. The effectiveness of the treatment was assessed by the dynamics of complaints, neurological syndromes (in points), neurosonographic parameters before and after the course of treatment.

The data obtained as a result of the study were processed using methods of mathematical statistics: the method of paired comparisons, methods of decision theory (Belkin A.R., Levin M.Sh. Decision making: combinatorial models of information approximation. M., Nauka, 1990 , - 160 pp. David G. The method of paired comparisons - M., Statistics, 1978), which allows to form integral (total) estimates for a set of indicators.

All children of the main group tolerated the galvanization procedure satisfactorily, no side effects were noted. In this group of children, according to parents, a positive trend in changes in complaints was noted: in 50% of children, night sleep returned to normal, every third child stopped spitting up; 22.22% of children after treatment did not respond to changes in weather conditions, in 25% of children the tremor of the chin and limbs disappeared.

An integral assessment of the dynamics of complaints in the main group is presented in Table 1.

From the data in Table 1 it follows that the inclusion of galvanization according to the orbito-occipital technique in the complex of therapeutic measures helps to reduce the severity and frequency of all major complaints.

In the control group of children, the positive dynamics is not so pronounced: normalization of sleep was noted only in 20% of children; only 13.33% of children stopped spitting up. In one child, after the first procedure, the parents noted a reaction to the treatment in the form of increased anxiety and an increase in the frequency of regurgitation. Tremor of the limbs and chin stopped in 2 children. Complaints about meteosensitivity were not noted only in one child.

An integral assessment of the dynamics of complaints in the control group is presented in Table 2.

According to integral estimates (Table 2), in the control group there is a tendency to reduce the severity and frequency of complaints of developmental delay and anxiety under the influence of electrophoresis on the cervical spine according to the Ratner method.

In the main group, after treatment according to the claimed method, 72.22% of children improved muscle tone, motor activity, unconditioned and tendon reflexes. Manifestations of autonomic dysfunction syndrome decreased in 53.33% of children. Clinical manifestations of HHS decreased in 33.33% of children.

An integral assessment of the dynamics of neurological syndromes in children of the main group is presented in Table 3.

From the data of table 3 it follows that the claimed method of treatment significantly reduces the severity and frequency of all major neurological syndromes. The best results were achieved in the treatment of SDR and VVS.

The use of eufillin electrophoresis on the cervical spine made it possible to reduce the incidence of SDR in 26.67% of children. A decrease in the frequency and severity of VVS was noted in 33.33% of children. In the control group, only 20% of children showed stabilization of the head size and a decrease in the severity of other clinical manifestations of HHS.

An integral assessment of the dynamics of neurological syndromes in children in the control group is presented in Table 4.

From the data in Table 4 it follows that electrophoresis according to the Ratner method had practically no effect on the severity and frequency of neurological syndromes (p=0.05). There is a slight trend towards a decrease in the severity and frequency of clinical manifestations of HHS and MRT.

The dynamics of neurosonographic parameters in children of the main group is presented in Table 5.

According to the results of neurosonographic studies (table 5), a pronounced positive trend was noted, consisting in the normalization of the size of liquor-containing structures. In the main group of children, the size of the lateral ventricles returned to normal in 35% of children. It was possible to achieve the elimination of hyporesorptive disorders in 25% of children.

27.04.2014, 19:21

Good evening, dear doctors. I am very worried about the situation that has developed at the moment based on the results of the NSG and examination by a neurologist. I read frequently asked questions, similar questions too, but it’s difficult for me, not being a doctor, to figure it out. I beg you, do not leave without attention. The baby was born at the 40th week, 3680 kg, 53 cm. head: 36 cm. The first NSG per month. MD=49mm MS=49mm VLD=12.8mm VLS=13.5mm V3=3.5mm. There is no offset. Bone-marrow diastasis = normal. M / P gap is not expanded. No pathologies were found. Despite this, I had complaints about the child's poor sleep (practically did not sleep until three and a half months, only in the fresh air), the effect of the "setting sun", shuddering, regurgitation. Head circumference per month 37 cm. Massage is prescribed. At three months, on examination by a neurologist okr. head: 43 cm. Hypotonia of the shoulder girdle. I have the same complaints. Appointed lingonberry decoction before vaccination, electrophoresis, glycine. Vaccination was not carried out due to obstructive bronchitis. Then he was examined by a neurologist at the age of 4 months in the hospital: neuro-reflex excitability syndrome. Recommended massage, nervoheel, turnout in two months.
NSG at 7 months: MD=57 mm MS=56 mm VLD=18.3 mm VLS=10.6 mm (18.6?, written very illegibly, the neurologist did not understand later), V3=3.5 mm. Bone-marrow diastasis = 4. There is no offset. M / P gap: 22x6. Violation of liquorodynamics by the type of hyposorption. I am attaching the result of the examination by a neurologist. Appointed triampur, pantocalcin. Appearance in 1.5 months. Vaccination medicine. The child received only BCG in the maternity hospital. From 30.03 - 7.04 he suffered from chicken pox, earlier obstructive bronchitis, stenosis of the larynx of the 2nd degree. At the moment, from complaints - shuddering, restless sleep, can wake up four times, sometimes crying in a dream with eyes closed, breastfeeding does not always help. Periodically there are red whites of the eyes. A week ago, he began to frequently "shake" his head from side to side, as if saying "no", involuntarily. Maybe even while feeding. Sometimes vomits. But earlier doctors told me that it was because of overfeeding or because of mobility immediately after eating. Of the "skills" - he rolls over, tries to sit down and crawl, but until he sits himself and crawls only in a plastunsky way, pronounces separate syllables. Active. Smiling, recognizes his. Breastfeeding + complementary foods (vegetables, fruits, cereals). Can you tell me if I should take the prescribed treatment? (For three days we have been drinking Triapur and Pantocalcin). When to repeat NSG? And is it dangerous? And if so, what? Thank you very much![Only registered and activated users can see links] ([Only registered and activated users can see links])

27.04.2014, 19:35

I would also like to add that the weight at the moment is 10 kg, 400 g, height is 69 cm, blood and urine tests are normal. In addition, rickets of the 2nd degree was made from the diagnoses, Vigantol was taken 4 drops for a month, now they switched to two. And the neurologist at the hospital at the age of four months already suspected violations of the liquor metabolism, asked to do stroking movements every day in the direction from the head to the feet, but in the conclusion he did not write anything, because. NSG was not done at that time.

28.04.2014, 12:16

Dear specialists, pediatric neurologists! I re-read the article about ICP and so on. on the forum. It is written that taking diuretic drugs is contraindicated, but what then to do? I didn’t understand, is an increase in the volume of cerebrospinal fluid this is hydrocephalus? How to treat it, if not promptly, as described in the article? Can it go away on its own? I understand that deviations from the norms in one direction or another are allowed, but as far as I can assess myself, our values ​​differ greatly from the norm. The child does not sleep for a week at night practically + everything that I described above. Although I do not rule out that this may be due to other factors. The norms of the growth of the volume of the head are not opened by the link. The phrase about the hydrocephalic shape of the skull is confusing. Help me, I can't find a place for myself anymore. I think, should I go to another specialist or continue treatment? The doctor who deciphered the NSG said "everything is bad with you." The neurologist just wrote a treatment plan. I would like to know if we are on the right track or do we need to do something fundamentally different or do nothing at all? Thank you very much in advance!

28.04.2014, 12:25

Write down the increase in head circumference by months (preferably with other parameters (body weight, chest circumference).
I would also like to see NSG scans (ultrasound of the head).

28.04.2014, 13:59

Stanislav Ilnurovich, thank you for responding! From the data I found on the map.
At birth: weight - 3680, height - 53, OG - 36, approx. gr. class - 35.
1 month: weight - 4554, height - 56, OG - 37, approx. gr. class - 36., native. 2.5x2.5
2 months 11 days: weight - 6140, height 60.
3 months: weight - 7100, height - 62, OG - 43, native. 3x3.
4 months 7 days: weight 8300, height - 63, OD - 44.5, approx. gr. class - 50.5.
7.5 months: weight 10400, height 69, OD 45, approx. gr. class 47, native 2x2.
Not everywhere there are parameters for the circumference of the head and chest, because. not every month they were measured in the clinic, but I did not assume that this was important. From 4 to 7 months, a break in measurements, because during this period, bronchitis, chickenpox just fell, they did not go to the clinic, weight gain was already less than kg / month.
Neurosonography at 7.5 months
Neurosonography at 1 month:
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28.04.2014, 15:13

It makes sense to look for a 2nd opinion.
According to the data presented, I consider the prescribed treatment inappropriate.
We observe in dynamics, we discuss.

Indications for brain echography

• Prematurity.
• neurological symptoms.
• Multiple stigmas of disembryogenesis.
• Indications of chronic intrauterine hypoxia in history.
• Asphyxia in childbirth.
• Syndrome of respiratory disorders in the neonatal period.
• Infectious diseases in mother and child.

To assess the state of the brain in children with an open anterior fontanel, a sector or microconvex sensor with a frequency of 5-7.5 MHz is used. If the fontanel is closed, then you can use sensors with a lower frequency - 1.75-3.5 MHz, but the resolution will be low, which gives the worst quality of echograms. When examining premature babies, as well as for assessing surface structures (sulci and convolutions on the convexital surface of the brain, extracerebral space), sensors with a frequency of 7.5-10 MHz are used.

Any natural opening in the skull can serve as an acoustic window for examining the brain, but in most cases a large fontanelle is used because it is the largest and last to close. The small size of the fontanel significantly limits the field of view, especially when assessing the peripheral parts of the brain.

To conduct an echoencephalographic study, the transducer is placed over the anterior fontanel, oriented so as to obtain a series of coronal (frontal) sections, and then turned 90° to perform sagittal and parasagittal scanning. Additional approaches include scanning through the temporal bone above the auricle (axial section), as well as scanning through open sutures, the posterior fontanel, and the atlanto-occipital articulation.

According to their echogenicity, the structures of the brain and skull can be divided into three categories:

• hyperechoic - bone, meninges, fissures, blood vessels, choroid plexuses, cerebellar vermis;
• medium echogenicity - parenchyma of the cerebral hemispheres and cerebellum;
• hypoechoic - corpus callosum, pons, cerebral peduncles, medulla oblongata;
• anechoic - liquor-containing cavities of the ventricles, cisterns, cavities of the transparent septum and Verge.

Normal variants of brain structures

Furrows and convolutions. The sulci appear as echogenic linear structures separating the gyri. Active differentiation of convolutions begins from the 28th week of gestation; their anatomical appearance precedes echographic imaging by 2–6 weeks. Thus, by the number and severity of the furrows, one can judge the gestational age of the child.

Visualization of the structures of the insular complex also depends on the maturity of the newborn child. In very premature babies, it remains open and is presented in the form of a triangle, a flag - as a structure of increased echogenicity without the definition of furrows in it. The closure of the Sylvian furrow occurs as the formation of the frontal, parietal, occipital lobes; complete closure of the islet with a clear Sylvian furrow and vascular formations in it ends by the 40th week of gestation.

Lateral ventricles. The lateral ventricles, ventriculi lateralis, are cavities filled with cerebrospinal fluid, visible as anechoic zones. Each lateral ventricle consists of an anterior (frontal), posterior (occipital), lower (temporal) horns, a body, and an atrium (triangle) - fig. 1. The atrium is located between the body, the occipital and parietal horn. The occipital horns are difficult to visualize, their width is variable. The size of the ventricles depends on the degree of maturity of the child, with an increase in gestational age, their width decreases; in mature children, they are normally slit-like. Slight asymmetry of the lateral ventricles (difference in the size of the right and left lateral ventricles on the coronal section at the level of the foramen of Monro up to 2 mm) is quite common and is not a sign of pathology. Pathological expansion of the lateral ventricles often begins with the occipital horns, so the lack of the possibility of their clear visualization is a serious argument against expansion. We can talk about the expansion of the lateral ventricles when the diagonal size of the anterior horns on the coronal section through the foramen of Monro exceeds 5 mm and the concavity of their bottom disappears.

Rice. one. The ventricular system of the brain.
1 - interthalamic ligament;
2 - supraoptic pocket of the III ventricle;
3 - funnel-shaped pocket of the III ventricle;

5 - hole Monroe;
6 - body of the lateral ventricle;
7 - III ventricle;
8 - pineal pocket of the III ventricle;
9 - glomerulus of the choroid plexus;
10 - posterior horn of the lateral ventricle;
11 - lower horn of the lateral ventricle;
12 - Sylvian plumbing;
13 - IV ventricle.

Vascular plexuses. The choroid plexus (plexus chorioideus) is a richly vascularized organ that produces cerebrospinal fluid. Sonographically, the plexus tissue appears as a hyperechoic structure. The plexuses pass from the roof of the third ventricle through the holes of Monro (interventricular holes) to the bottom of the bodies of the lateral ventricles and continue to the roof of the temporal horns (see Fig. 1); they are also present in the roof of the fourth ventricle, but are not detected echographically in this area. The anterior and occipital horns of the lateral ventricles do not contain choroid plexuses.

The plexuses usually have an even, smooth contour, but there may be irregularities and slight asymmetry. The choroid plexuses reach their greatest width at the level of the body and the occipital horn (5-14 mm), forming a local seal in the atrium area - the vascular glomerulus (glomus), which can be in the form of a finger-shaped outgrowth, be layered or fragmented. On coronal sections, the plexuses in the occipital horns look like ellipsoidal densities, almost completely filling the lumen of the ventricles. In children with a lower gestational age, the size of the plexuses is relatively larger than in full-term ones.

The choroid plexuses can be a source of intraventricular hemorrhages in full-term children, then their clear asymmetry and local seals are visible on the echograms, in the place of which cysts then form.

III ventricle. The third ventricle (ventriculus tertius) is a thin slit-like vertical cavity filled with cerebrospinal fluid, located sagittally between the thalamus above the Turkish saddle. It connects to the lateral ventricles through the foramen of Monro (foramen interventriculare) and to the IV ventricle through the Sylvian aqueduct (see Fig. 1). The supraoptic, funnel-shaped and pineal processes give the third ventricle a triangular appearance on the sagittal section. On the coronal section, it is visible as a narrow gap between the echogenic visual nuclei, which are interconnected by an interthalamic commissure (massa intermedia) passing through the cavity of the third ventricle. In the neonatal period, the width of the third ventricle in the coronal section should not exceed 3 mm, in infancy - 3-4 mm. The clear outlines of the third ventricle on the sagittal section indicate its expansion.

Sylvius aqueduct and IV ventricle. The aqueduct of Sylvius (aquaeductus cerebri) is a thin canal connecting the III and IV ventricles (see Fig. 1), rarely visible on ultrasound in standard positions. It can be visualized on the axial section as two echogenic dots against the background of hypoechoic cerebral peduncles.

IV ventricle (ventriculus quartus) is a small diamond-shaped cavity. On echograms in a strictly sagittal section, it looks like a small anechoic triangle in the middle of the echogenic medial contour of the cerebellar vermis (see Fig. 1). Its anterior border is not clearly visible due to the hypoechogenicity of the dorsal part of the bridge. The anteroposterior size of the IV ventricle in the neonatal period does not exceed 4 mm.

Calloused body. The corpus callosum (corpus callosum) on the sagittal section looks like a thin horizontal arcuate hypoechoic structure (Fig. 2), bounded above and below by thin echogenic strips resulting from reflection from the corpus callosum (from above) and the lower surface of the corpus callosum. Immediately below it are two sheets of a transparent partition, limiting its cavity. On the frontal section, the corpus callosum looks like a thin narrow hypoechoic strip forming the roof of the lateral ventricles.

Rice. 2. The location of the main brain structures on the median sagittal section.
1 - varolian bridge;
2 - prepontine cistern;
3 - interpeduncular cistern;
4 - transparent partition;
5 - legs of the arch;
6 - corpus callosum;
7 - III ventricle;
8 - cistern of the quadrigemina;
9 - legs of the brain;
10 - IV ventricle;
11 - a large tank;
12 - medulla oblongata.

The cavity of the transparent septum and the cavity of Verge. These cavities are located directly under the corpus callosum between the sheets of the transparent septum (septum pellucidum) and are limited by glia, not ependyma; they contain fluid but do not connect to either the ventricular system or the subarachnoid space. The cavity of the transparent septum (cavum cepti pellucidi) is located anterior to the fornix of the brain between the anterior horns of the lateral ventricles, the Verge cavity is located under the ridge of the corpus callosum between the bodies of the lateral ventricles. Sometimes, normally, dots and short linear signals originating from the subependymal median veins are visualized in the sheets of the transparent septum. On the coronal section, the cavity of the septum pellucidum looks like a square, triangular or trapezoidal anechoic space with a base under the corpus callosum. The width of the cavity of the transparent septum does not exceed 10-12 mm and is wider in premature infants than in full-term ones. Verge's cavity, as a rule, is narrower than the cavity of the transparent septum and is rarely found in full-term children. These cavities begin to obliterate after 6 months of gestation in the dorsoventral direction, but there are no exact dates for their closure, and both of them can be found in a mature child at the age of 2-3 months.

Basal nuclei, thalamus and internal capsule. The optic nuclei (thalami) are spherical hypoechoic structures located on the sides of the cavity of the transparent septum and forming the lateral borders of the third ventricle on coronal sections. The upper surface of the gangliothalamic complex is divided into two parts by the caudothalamic notch - the anterior one belongs to the caudate nucleus, the posterior one to the thalamus (Fig. 3). The visual nuclei are connected to each other by an interthalamic commissure, which becomes clearly visible only with the expansion of the third ventricle both on the frontal (in the form of a double echogenic transverse structure) and on the sagittal sections (in the form of a hyperechoic dot structure).

Rice. 3. The relative position of the structures of the basal-thalamic complex on the parasagittal section.
1 - shell of the lenticular nucleus;
2 - pale ball of the lenticular nucleus;
3 - caudate nucleus;
4 - thalamus;
5 - inner capsule.

The basal ganglia are subcortical collections of gray matter located between the thalamus and the insula of Rayleigh. They have similar echogenicity, which makes them difficult to differentiate. A parasagittal section through the caudothalamic notch is the most optimal approach for detecting the thalamus, the lentiform nucleus, consisting of the shell (putamen), and the pale ball, (globus pallidus), and the caudate nucleus, as well as the internal capsule - a thin layer of white matter that separates the nuclei of the striatum bodies from the thalamus. A clearer visualization of the basal nuclei is possible when using a 10 MHz probe, as well as in pathology (hemorrhage or ischemia) - as a result of neuronal necrosis, the nuclei acquire increased echogenicity.

germinal matrix is an embryonic tissue with high metabolic and fibrinolytic activity, producing glioblasts. This subependymal plate is most active between the 24th and 34th weeks of gestation and is an accumulation of fragile vessels, the walls of which are devoid of collagen and elastic fibers, are easily ruptured and are a source of peri-intraventricular hemorrhages in preterm infants. The germinal matrix lies between the caudate nucleus and the lower wall of the lateral ventricle in the cau- thalamic notch, and looks like a hyperechoic strip on echograms.

Cisterns of the brain. Cisterns are spaces containing cerebrospinal fluid between brain structures (see Fig. 2), which may also contain large vessels and nerves. Normally, they are rarely seen on echograms. When enlarged, the cisterns look like irregularly delineated cavities, which indicates a proximally located obstruction to the flow of cerebrospinal fluid.

The large cistern (cisterna magna, c. cerebromedullaris) is located under the cerebellum and medulla oblongata above the occipital bone, normally its upper-lower size on the sagittal section does not exceed 10 mm. The pontine cistern is an echogenic area above the pons in front of the cerebral peduncles, under the anterior pocket of the third ventricle. It contains a bifurcation of the basilar artery, which causes its partial echo density and pulsation.

Basal (c. suprasellar) cistern includes interpeduncular, c. interpeduncularis (between the legs of the brain) and chiasmatic, c. chiasmatis (between the optic chiasm and the frontal lobes) cisterns. The cisterna decussation looks like a pentagonal echo-dense zone, the corners of which correspond to the arteries of the circle of Willis.

The cistern of the quadrigemina (c. quadrigeminalis) is an echogenic line between the plexus of the third ventricle and the cerebellar vermis. The thickness of this echogenic zone (normally not exceeding 3 mm) may increase with subarachnoid hemorrhage. In the region of the cistern of the quadrigemina, there may also be arachnoid cysts.

Bypass (c. ambient) cistern - carries out lateral communication between the prepontine and interpeduncular cistern in front and the cistern of the quadrigemina behind.

Cerebellum(cerebellum) can be visualized through both the anterior and posterior fontanel. When scanning through a large fontanelle, the image quality is the worst due to the long distance. The cerebellum consists of two hemispheres connected by a worm. The hemispheres are slightly echogenic, the worm is partially hyperechoic. On the sagittal section, the ventral part of the worm looks like a hypoechoic letter "E" containing cerebrospinal fluid: at the top - the quadrigeminal cistern, in the center - the IV ventricle, below - a large cistern. The transverse size of the cerebellum directly correlates with the biparietal diameter of the head, which makes it possible to determine the gestational age of the fetus and newborn based on its measurement.

The cerebral peduncles (pedunculus cerebri), the pons (pons) and the medulla oblongata (medulla oblongata) are located longitudinally anterior to the cerebellum and look like hypoechoic structures.

Parenchyma. Normally, there is a difference in echogenicity between the cerebral cortex and the underlying white matter. The white matter is slightly more echogenic, possibly due to the relatively larger number of vessels. Normally, the thickness of the cortex does not exceed a few millimeters.

Around the lateral ventricles, predominantly over the occipital and less frequently over the anterior horns, premature infants and some full-term infants have a halo of increased echogenicity, the size and visualization of which depend on gestational age. It can persist up to 3-4 weeks of life. Normally, its intensity should be lower than that of the choroid plexus, the edges should be fuzzy, and the location should be symmetrical. With asymmetry or increased echogenicity in the periventricular region, an ultrasound study of the brain in dynamics should be performed to exclude periventricular leukomalacia.

Standard echoencephalographic sections

Coronal slices(Fig. 4). First cut passes through the frontal lobes in front of the lateral ventricles (Fig. 5). In the middle, the interhemispheric fissure is determined in the form of a vertical echogenic strip separating the hemispheres. When it expands, a signal from the crescent of the brain (falx) is visible in the center, which is not visualized separately in the norm (Fig. 6). The width of the interhemispheric fissure between the gyri does not normally exceed 3-4 mm. On the same section, it is convenient to measure the size of the subarachnoid space - between the lateral wall of the superior sagittal sinus and the nearest gyrus (sinocortical width). To do this, it is desirable to use a sensor with a frequency of 7.5-10 MHz, a large amount of gel and very carefully touch the large fontanelle without pressing on it. The normal size of the subarachnoid space in full-term children is up to 3 mm, in premature babies - up to 4 mm.

Rice. four. Planes of coronal scanning (1-6).

Rice. 5. Echogram of the brain of a newborn, the first coronal section through the frontal lobes.
1 - eye sockets;
2 - interhemispheric fissure (not expanded).

Rice. 6. Measurement of the width of the subarachnoid space and the width of the interhemispheric fissure on one or two coronal sections - scheme (a) and echogram of the brain (b).
1 - superior sagittal sinus;
2 - the width of the subarachnoid space;
3 - width of the interhemispheric fissure;
4 - crescent of the brain.

Second cut is performed through the anterior horns of the lateral ventricles anterior to the foramina of Monro at the level of the cavity of the transparent septum (Fig. 7). Frontal horns that do not contain CSF are visualized on both sides of the interhemispheric fissure as echogenic stripes; in the presence of CSF in them, they look like anechoic structures, similar to boomerangs. The roof of the anterior horns of the lateral ventricles is represented by a hypoechoic strip of the corpus callosum, and between their medial walls there are leaves of a transparent septum containing a cavity. On this section, the shape is evaluated and the width of the cavity of the transparent partition is measured - the maximum distance between its walls. The lateral walls of the anterior horns form the basal nuclei - directly under the bottom of the horn - the head of the caudate nucleus, laterally - the lenticular nucleus. Even more lateral on this section, on both sides of the cisterna decussation, the temporal lobes are determined.

Rice. 7. Echogram of the brain, second coronal section through the anterior horns of the lateral ventricles.
1 - temporal lobes;
2 - Sylvian fissure;
3 - cavity of a transparent partition;
4 - anterior horn of the lateral ventricle;
5 - corpus callosum;
6 - interhemispheric fissure;
7 - caudate nucleus;
8 - thalamus.

Third coronal section passes through the holes of Monro and III ventricle (Fig. 8). At this level, the lateral ventricles connect with the third ventricle through the interventricular foramina (Monroe). The holes themselves are not normally visible, but the choroid plexuses passing through them from the roof of the third ventricle to the bottom of the lateral ventricles look like a hyperechoic Y-shaped structure located along the midline. Normally, the third ventricle may also not be visualized; when it is enlarged, its width is measured between the medial surfaces of the thalamus, which are its lateral walls. The lateral ventricles on this section are seen as slit-like or boomerang-shaped anechoic structures (Fig. 9), the width of which is measured diagonally (normally up to 5 mm). The cavity of the transparent septum on the third section in some cases still remains visible. Below the third ventricle, the brain stem and pons are visualized. Laterally from the third ventricle - the thalamus, the basal nuclei and the islet, over which a Y-shaped thin echogenic structure is defined - the Sylvian fissure containing the pulsating middle cerebral artery.

Rice. eight. Echogram of the brain, the third coronal section through the holes of Monro.
1 - III ventricle;
2 - choroid plexuses in the interventricular canals and the roof of the third ventricle and the fornix of the brain;
3 - cavity of the lateral ventricle;
4 - corpus callosum;
5 - caudate nucleus;
6 - thalamus.

Rice. 9. The relative position of the central brain structures on two to four coronal sections.
1 - III ventricle;
2 - cavity of a transparent partition;
3 - corpus callosum;
4 - lateral ventricle;
5 - caudate nucleus;
6 - leg of the fornix of the brain;
7 - thalamus.

On the fourth cut(through the bodies of the lateral ventricles and the posterior section of the third ventricle) are visible: interhemispheric fissure, corpus callosum, ventricular cavities with choroid plexuses in their bottom, thalamus, Sylvian fissures, vertically located hypoechoic brain legs (below the thalamus), the cerebellum, separated from the brain legs by hyperechoic bait (Fig. 10). A large cistern can be visualized downward from the cerebellar vermis. In the region of the middle cranial fossa, a site of pulsation is visible, originating from the vessels of the circle of Willis.

Rice. ten. Echogram of the brain, the fourth coronal section through the bodies of the lateral ventricles.
1 - cerebellum;
2 - vascular plexuses in the lateral ventricles;
3 - bodies of the lateral ventricles;
4 - Verge cavity.

Fifth cut passes through the bodies of the lateral ventricles and the choroid plexuses in the region of the glomus, which on the echograms almost completely fill the cavities of the lateral ventricles (Fig. 11). On this section, a comparison is made of the density and size of the choroid plexuses on both sides to exclude hemorrhages. In the presence of the Verge cavity, it is visualized between the lateral ventricles in the form of a rounded anechoic formation. Inside the posterior cranial fossa, the cerebellum is visualized with an average echogenicity, above its insignia is the echogenic cistern of the quadrigemina.

Rice. eleven. Echogram of the brain, the fifth coronal section through the choroid plexus glomus - choroid plexuses in the area of ​​the atria, completely fulfilling the lumen of the ventricles (1).

Sixth, the last, coronal section is performed through the occipital lobes above the cavities of the lateral ventricles (Fig. 12). The interhemispheric fissure with furrows and convolutions is visualized in the middle, on both sides of it there are cloud-like periventricular seals, which are more pronounced in premature babies. On this section, the symmetry of these seals is evaluated.

Rice. 12. Echogram of the brain, sixth coronal section through the occipital lobes above the lateral ventricles.
1 - normal periventricular seals;
2 - interhemispheric fissure.

Sagittal slices(Fig. 13). mid-sagittal section(Fig. 14) allows visualization of the corpus callosum in the form of a hypoechoic arc, immediately below it is the cavity of the transparent septum (under its anterior sections) and the Verge cavity connected to it (under the ridge). A pulsating structure passes near the knee of the corpus callosum - the anterior cerebral artery, which goes around it and runs along the upper edge of the body. A corpus callosum passes over the corpus callosum. Between the cavities of the transparent septum and Verge, an arcuate hyperechoic strip is determined, originating from the choroid plexus of the third ventricle and the fornix of the brain. Below is a hypoechoic triangular third ventricle, the contours of which are normally not clearly defined. With its expansion in the center, you can see the interthalamic adhesion in the form of a hyperechoic point. The posterior wall of the third ventricle is made up of the pineal gland and the quadrigemnal plate, behind which the quadrigemnal cistern can be seen. Immediately below it, in the posterior cranial fossa, a hyperechoic cerebellar vermis is determined, on the anterior part of which there is a triangular notch - the IV ventricle. The pons, cerebral peduncles, and medulla oblongata are located anterior to the fourth ventricle and are seen as hypoechoic masses. On this section, a large cistern is measured - from the lower surface of the worm to the inner surface of the occipital bone - and the depth of the IV ventricle is measured. 5 - corpus callosum;
6 - the cavity of the transparent partition;
7 - legs of the brain;
8 - a large tank;
9 - Verge cavity;
10 - corpus callosum;
11 - cavity of a transparent partition;
12 - III ventricle.

With a slight deviation of the sensor to the left and right, parasagittal section through the caudothalamic notch (the location of the germinal matrix in premature babies), on which its shape is assessed, as well as the structure and echogenicity of the gangliothalamic complex (Fig. 15).

Rice. fifteen. Echogram of the brain, parasagittal section through the caudo-thalamic notch.
1 - choroid plexus of the lateral ventricle;
2 - cavity of the lateral ventricle;
3 - thalamus;
4 - caudate nucleus.

Next parasagittal section is performed through the lateral ventricle on each side so as to obtain its complete image - the frontal horn, body, occipital and temporal horns (Fig. 16). In this plane, the height of various sections of the lateral ventricle is measured, the thickness and shape of the choroid plexus are assessed. Above the body and the occipital horn of the lateral ventricle, the homogeneity and density of the periventricular substance of the brain is assessed, comparing it with the density of the choroid plexus.

Rice. 17. Echogram of the brain, parasagittal section through the temporal lobe.
1 - temporal lobe of the brain;
2 - Sylvian fissure;
3 - parietal lobe.

If any abnormalities are detected on the obtained echograms in the coronal section, then they must be confirmed in the sagittal section, and vice versa, since artifacts can often occur.

axial scan. An axial cut is made by placing the transducer horizontally over the ear. At the same time, the legs of the brain are visualized as a hypoechoic structure that looks like a butterfly (Fig. 18). Between the legs, often (unlike coronal and sagittal sections), an echogenic structure is visible, consisting of two points - the Sylvian aqueduct, anterior to the legs - the slit-like third ventricle. On the axial section, the walls of the third ventricle are clearly visible, in contrast to the coronal one, which makes it possible to more accurately measure its size with a slight expansion. When the probe is tilted towards the cranial vault, the lateral ventricles are visible, which makes it possible to estimate their size when the large fontanel is closed. Normally, the parenchyma of the brain is closely adjacent to the bones of the skull in mature children; therefore, the separation of echo signals from them in the axial section suggests the presence of pathological fluid in the subarachnoid or subdural spaces.

Rice. eighteen. Echogram of the brain, axial section at the level of the base of the brain.
1 - cerebellum;
2 - Sylvian water supply;
3 - legs of the brain;
4 - Sylvian fissure;
5 - III ventricle.

Data from an echographic study of the brain can be supplemented by the results of a Doppler assessment of cerebral blood flow. This is desirable, since in 40-65% of children, despite severe neurological disorders, the data of the echographic examination of the brain remain normal.

The brain is supplied with blood by branches of the internal carotid and basilar arteries, which form the circle of Willis at the base of the brain. The direct continuation of the internal carotid artery is the middle cerebral artery, the smaller branch is the anterior cerebral artery. The posterior cerebral arteries branch off from the short basilar artery and communicate with branches of the internal carotid via the posterior communicating arteries. The main cerebral arteries - the anterior, middle and posterior, form an arterial network with their branches, from which small vessels that feed the cortex and white matter of the brain penetrate into the medulla.

Doppler examination of blood flow is carried out in the largest arteries and veins of the brain, trying to position the ultrasound sensor so that the angle between the ultrasound beam and the axis of the vessel is minimal.

anterior cerebral artery visualized on the sagittal section; to obtain blood flow indicators, a volume marker is placed in front of the knee of the corpus callosum or in the proximal part of the artery before it bends around this structure.

For the study of blood flow internal carotid artery on the parasagittal section, its vertical part is used immediately after exiting the carotid canal above the level of the Turkish saddle.

basilar artery examined in the median sagittal section in the region of the base of the skull immediately in front of the bridge a few millimeters behind the location of the internal carotid artery.

Middle cerebral artery determined in the Sylvian fissure. The best angle for its insonation is achieved with an axial approach. The vein of Galen is visualized on a coronal section under the corpus callosum along the roof of the third ventricle.