0:01

This is a companion case of that, uh, patient who had, uh,

0:05

enlarged extra axial spaces.

0:07

It's a different patient population.

0:09

So this was a seven month old.

0:11

So this patient is out of the nicu, um, uh, discharged home

0:15

or, uh, you know, out, out of the newborn nursery,

0:18

but came to head ultrasound screening to

0:21

because of an enlarging head circumference.

0:23

So this is a different patient population from that, uh,

0:26

newborn who's been in the NICU their whole life.

0:28

Uh, this is a developmentally normal neurologic exam is

0:32

normal infant who is seven months old.

0:35

So when we see these large extra axial spaces,

0:38

we're gonna be thinking a little bit differently than the

0:40

infant who had the enlarged subarachnoid spaces

0:43

and subdural collections who was located in the nicu.

0:47

So on our coronal plane, small footprint, curved array,

0:50

baby head transducer, we immediately see

0:52

that these are some big X extra axial spaces at

0:55

the vertex in this infant.

0:57

Um, these ventricles are at the upper limit of normal, uh,

1:01

for size on this right side.

1:03

This is a, a somewhat pointy frontal horn

1:05

lateral ventricle on the right side.

1:07

On the left side, it's a little bit rounded

1:08

and the left lateral ventricle is

1:10

a little larger than our right.

1:11

So not only do we have enlarged extra axial spaces,

1:14

we have some mild lateral ventricular magaly as well.

1:17

So let's see if we see any explanation for that

1:19

or if that's all we see.

1:21

Um, I don't see any abnormal echogenic material in either

1:25

of the cerebral hemispheres.

1:28

The, uh, choroid plexus is the brightest structure I see in

1:31

the super tentorial brain.

1:33

We have nice normal sulfation

1:35

with a well-formed cingulate sulcus

1:39

or, uh, sylvan fissures look normal bilaterally.

1:42

When we come to the sagittal plane,

1:43

we have a normal corpus clem.

1:45

We have normal posterior FoST structures, what we see

1:48

of fourth ventricle looks normal.

1:49

Cis sternum, magna looks normal.

1:52

As we're coming off to the right side of the brain,

1:54

I don't see any abnormal epigenic foci.

1:57

I don't see any abnormal architectural distortion

2:00

or like globular genic foci to suggest hemorrhage.

2:04

Now we're going midline to the left.

2:06

Again, the cord plexus is definitely the brightest

2:08

structure in this brain.

2:09

Parenchyma. I don't see any Glo, epigenic foci.

2:13

Our sci all of normal.

2:15

Our Gyre have nice normal preserved morphology.

2:18

As we angle off axis, the extra axial spaces along the right

2:23

calvarium look normal.

2:25

Similarly on the left, uh,

2:27

actually we do see just a little bit

2:28

of prominent extra axial spaces on the left side over here.

2:33

Now we switch to our linear high frequency transducer

2:35

and magnify to get a better look at the extra axial spaces.

2:39

At the vertex, we have a normal looking gray scale

2:42

appearance of the superior sagittal dur venous sinus.

2:45

I don't see any displays linear, um, abnormal

2:50

dura mater here in this image.

2:52

When we look with color doppler, I see normal

2:55

bridging veins extending all the way through these

2:58

Extra axial spaces.

3:00

So this is all just the subarachnoid space.

3:03

I don't see anything that looks like a superimposed

3:06

subdural collection in this infant.

3:08

The sonographer put on color doppler imaging in the sagittal

3:11

plane as well to show us

3:13

that not only is this superior sagittal dural venous sinus

3:16

patent, but these bridging venous structures

3:18

are patent as well.

3:20

And again, we don't see any displaced

3:22

ura mater here at the Vertex.

3:24

So, um, in an infant who is between the ages of six

3:27

to nine months, developing normal,

3:29

totally normal neurological examination.

3:32

This is what we call benign macro cranial

3:34

or benign enlargement of the subarachnoid spaces of infancy.

3:38

Um, we'll just make sure that the pediatrician

3:40

or the neonatologist

3:42

who referred this infant keeps a close eye on the

3:44

development of this infant.

3:46

Make sure that they're, uh, developing normally.

3:48

But, uh, we don't have to recommend any other additional

3:50

imaging in this infant to confirm that this is, uh,

3:53

just a normal variant appearance of large extra axial spaces

3:58

that are subarachnoid

3:59

and ventricles that are up at the upper limit of normal

4:02

for size or mildly enlarged with benign macro cranium.

4:05

You can have normal sized ventricles

4:07

or a little bit of lateral ventricular magaly,

4:09

but there should never be any mass effect

4:11

or anything else abnormal that we see on these, um, infants.

4:14

And again, they have a normal, um, birth history

4:18

and normal exam and, uh, development.

4:21

Uh, when they see their pediatrician.