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Marwan	Alhalabi		MD	PhD
Professor	in	Reproductive	Medicine	
Faculty	of	Medicine	
Damascus	University
&
Clinical	Medical	Director	
Orient	Hospital	
Assisted	Reproduction	Center	
Damascus,	Syria.
The	human	brain	is	
the	most	complex	
mass	of	
protoplasm	on	
earth-perhaps	
even	in	our	
galaxy.
•
6
Brain	Development
• The spinal	
cord	develops	
from	the	
caudal	2/3 of	
the	neural	
tube
Caudal portion
Rostral portion
mesencephalon
metencephalon
myelencephalon
6 weeks4 weeks
• Pineal	gland:	sleep-wake	
cycle,	secretes	melatonin.
• Epithalamus:	masticatory	
and	swallowing	functions.
• Thalamus:	major	relay	of	
sensory	input	to	cerebral	
cortex.
Diencephalon
2
Microcephaly
Anencephaly
Chiari0Malforma3on


 Head normal or smallHead normal or small
DiaDia



halus , T 21halus , T 21
Ventriculomegaly
HydranceHydrance
Hydranecphaly
Encephalocele
Occipital EncephaloceleOccipital Encephalocele
Imaging FindingsImaging Findings
 Herniated brain tissueHerniated brain tissue
 „„cyst within the cystcyst within the cyst““
 Ventriculomegaly 70Ventriculomegaly 70--
80%80%
 Microcephaly 25%Microcephaly 25%
 PolyhydramniosPolyhydramnios
 OligohydramniosOligohydramnios
CAVE:CAVE:
 Associated with multipleAssociated with multiple
syndroms ( Meckelsyndroms ( Meckel-- Gruber )Gruber )
Pilu
Holoprosencephaly
Hemimegalencephaly Arachnoid0cyst
ACC
SOP
Schizencephaly
SchizencephalySchizencephaly
PFAFluidACyst
Yong seok et a
Vascular0
Malforma3ons
Circle of Willis MallformationCircle of Willis Mallformation
Sonography&of&the&CNS
Basic0Examination “Neurosongram”
Planes0of0Basic0Examina3on
Axial0Planes Sagibal0Planes
Sunday, July 28, 13
Axial0Planes
Axial0Planes
a:0Transventricular
Axial0Planes
a:0Transventricular
b:0Transthalamic0
Axial0Planes
a:0Transventricular
C:0Transcerebeller0
b:0Transthalamic0
The0Transventricular0plane
The0Transventricular0plane
Frontal0hones
The0Transventricular0plane
Frontal0hones
Atrium
The0Transthalamic00Plane
T
T
The0Transcerebeller00plane
Cavum0Sep30Pellucidi
T
T
The0Transcerebeller00plane
Cavum0Sep30Pellucidi
Frontal0hones
T
T
The0Transcerebeller00plane
Sagibal0Planes00
Sagibal0Planes00
A:0The0Midsagittal0
Plan
Sagibal0Planes00
b:0Parasgittal0plane
A:0The0Midsagittal0
Plan
Corpus0Callosum
Lateral0Ventricles
Third0Ventricle
midbrain
Pituitary
Splenium
Thalamus
hypothalamus
Fourth0ventricle
The0Corpus0Callosum
ParaHSagiGal&Plane&
30
Basic Examniation ChecklistBasic Examniation Checklist
Head + NeckHead + Neck
Midline & FalxMidline & Falx
Cavum septi pellucidiCavum septi pellucidi
Lateral cerebral ventriclsLateral cerebral ventricls
Choroid PlexusChoroid Plexus
CerebellumCerebellum
Cisterna magnaCisterna magna
Sunday, July 28, 13
• Head	&	Neck
• Midline	&	Falx
• Cavum septipellucidi
• Lateral	cerebral	ventricles
• Choroid	plexus
• Cerebellum
• Cisterna	magna
32
Microcephaly
Anencephaly
Chiari0Malforma3on


 Head normal or smallHead normal or small
DiaDia



halus , T 21halus , T 21
Ventriculomegaly
HydranceHydrance
Hydranecphaly
Encephalocele
Occipital EncephaloceleOccipital Encephalocele
Imaging FindingsImaging Findings
 Herniated brain tissueHerniated brain tissue
 „„cyst within the cystcyst within the cyst““
 Ventriculomegaly 70Ventriculomegaly 70--
80%80%
 Microcephaly 25%Microcephaly 25%
 PolyhydramniosPolyhydramnios
 OligohydramniosOligohydramnios
CAVE:CAVE:
 Associated with multipleAssociated with multiple
syndroms ( Meckelsyndroms ( Meckel-- Gruber )Gruber )
Pilu
Holoprosencephaly
Hemimegalencephaly Arachnoid0cyst
ACC
SOP
Schizencephaly
SchizencephalySchizencephaly
PFAFluidACyst
Yong seok et a
Vascular0
Malforma3ons
Circle of Willis MallformationCircle of Willis Mallformation
(<#10#mm#is#normal).##Independent#
of#gesta7onal#age#
Mild&10&–&15&mm
Low&Risk&
Severe&>&15&mm&
High&Risk&
mean#=#6:8#
mm
Ventriculomegaly0(hydrocephalus)
•Square0Shaped,0Interrupts0and0Fills0The0Space0Between0The0Frontal0Horns
•The0CSP:0Becomes0Visible0At01600Weeks,0Obliterate0Near0Term
Absent0CSP
Blake’s&pouch&cyst Megacisterna&magna DHW&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
Findings
Upward0rotation0of0an0intact0vermis0
with0normal0torcular
Cisterna0magna0>10mm0with0intact0
and0normally0positioned0cerebellum
Upward0rotation0of0the0vermis0
(normal0or0hypoplastic)0with
elevated0torcular
SagiGal&
Axial
Categoriza3on0of0posterior0fossa0fluid0collec3ons0(1)
78

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