MKP VENTRICULOMEGALY - keywords
A
fetal
B
C
postnatal
shunt
25
D
E
F
5
2
1
3
6
4
7
8
ACA RI 0.99
absent diastolic
velocities in ACA
due to severe
hydrocephaly
with Chiari type
II malformation
growth retarded infant with
posthaemorrhagic
hydrocephalus
(top) 7.5MHz images
(bottom) Doppler flow
velocities in the ACA before
(left) and after (right) the
first lumbar puncture,
yielding 20 mL clear fluid
an increase of diastolic flow
velocities is clearly seen
following release of
pressure by lumbar
puncture
drainage via
arachnoid villi in
venous sinus
7
1
3
2
1
4
8
1
13
6
5
2
12
2
10
A
5
9
11
6
B
9
16
7
lymphatic drainage
along spinal and cranial
nerves
7
4
2
2
8
3
14
15
10
11
A
V
15
classic view of fluid
production and transport
(inset: choroid plexus CSF
production)
1
2
3
4
5
6
7
8
9
sinus
choroid plexus
foramen of Magendi
foramen of Luschka
diencephalon
mesencephalon
cerebellum
arachnoid villi
ependyma
updated view including
glymphatics
A intrinsic fluid production and
transport
B choroid plexus CSF production
1 pia mater glia limitans externa
(aquaporin 4)
2 astrocyte
3 connected other astrocyte
4 neuron
5 axon
6 capillary
7 superior sagittal sinus
8 transverse sinus
9 lateral ventricle choroid plexus
10 brain interstitial fluid
11 MCA perforator with VirchowRobin space (aquaporin 4)
12 efflux in perivenous lymphatic
space
13 glymphatic (astrocytic fluid
channel)
14 subarachnoid space (periolfactory)
15 nasal submucosal lymphatic
16 dural true lymphatics
v3 suprapineal recess
v4 lateral recess
mechanisms behind ventricular dilatation
inferior (temporal) horn
5
posterior (occipital) horn
v4 posterior recess
body of lateral ventricle
anterior (frontal) horn
6
optic recess
v4
2
3
1
foramen of Monro
body of lateral ventricle
anterior (frontal) horn
posterior horn
v3
4
anterior commissure
optic recess
aqueduct
optic commissure
v4 posterior recess
v4
inferior (temporal) horn
v4 lateral recess
infundibular recess
1
2
3
4
intraventricular obstruction
ex vacuo dilatation
overproduction of CSF
extraventricular obstruction
5 disturbed resorption
6 abnormal glymphatic
drainage
25w GA, IVH with evolution to isolated fourth ventricle
day 21
day 120, Rickham reservoir on day 40
cystic v4
clot in v4
stenosis at the foramen of Monro (fetal unilateral
ventricular dilatation)
term, mild macrocephaly, mosaic trisomy 9, plexus hypertrophy,
plexus coagulation at 6 months of age
preterm IVH with posthaemorrhagic ventriculomegaly
hyperechoic
aqueduct
flow to v4
clot in cisterna magna
axial mastoid insonation
lateral ventricle
flow from v4
v3
aqueduct with
limited clot
fragments
GMH/IVH
venous congestion with limited
infarction
retrocerebellar clot invested in
pial surface
GMH
cerebellar haematoma
early venous infarction
GMH
porencephalisation of a venous infarct
different aspects of medullary venous infarction
venous infarction in corpus callosum
IVH
microthrombosis and fibrosis
in arachnoid tissue
inflammation
haemoglobin toxicity
damage to CSF-brain barrier
at ependymal lining
impaired CSF flow
altered expression of
aquaporin channels
progressive
ventricular dilatation
effect on tissue
perfusion
increased intracranial
pressure
tissue distorsion
grey and white
matter injury