The interhemispheric gap in children is normal. Expansion of the interhemispheric gap in children consequences

Neurosonography (NSG) is a term applied to the study of the brain of a young child: a newborn and an infant until the fontanelle 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 polyclinic in the 1st month of life as part of screening. Further, 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 according to the doctor's prescription. 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 neurosonography is able to preserve the health, and sometimes even the life of the child.

Indications for neurosonography

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

fetal hypoxia;
asphyxia of newborns;
difficult labor (accelerated / prolonged, with the use of obstetric aid);
intrauterine fetal infection;
birth trauma of newborns;
infectious diseases of the mother during gestation;
rhesus conflict;
cesarean 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;
sinking / protrusion of the fontanel in newborn children;
suspicion of chromosomal abnormalities (according to a screening study during pregnancy).

Having a baby by caesarean section, despite its prevalence, is quite traumatic for an infant. Therefore, babies with such a history are obliged to undergo NSH for early diagnosis of possible pathology.

Indications for ultrasound examination within a month:

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

In addition to the main reasons, which are serious pathological conditions, NSH is prescribed in the case when the child has a fever for more than a month and has no obvious reasons.

Preparation and method of conducting research

Neurosonography does not require preliminary preparation. A baby should not be hungry or thirsty. If the baby has fallen asleep, you do not need 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 with you milk for babies, a diaper to put the newborn baby on the couch. Before the NSG procedure, you do not need to apply creams or ointments to the fontanel area, even if there is an indication for this. This worsens the contact of the sensor with the skin, and also negatively affects the visualization of the studied organ.

The procedure is no different from any ultrasound scan. The newborn or baby is placed on a couch, the place of contact of the skin with the sensor is lubricated with a special gel substance, after which the doctor performs neurosonografia.

Access to the structures of the brain with ultrasound is possible through the large fontanelle, the thin bone of the temple, the anterior and posterior 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. Deciphering 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 echogenicity of tissues. 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 - symmetric / asymmetric;
visualization of grooves and convolutions (should be clearly visualized);
condition, shape and location of cerebellar structures (tentation);
the state of the cerebral sickle (thin hyperechoic streak);
presence / absence of fluid in the interhemispheric gap (fluid should be absent);
homogeneity / heterogeneity and symmetry / asymmetry of the ventricles;
the state of the cerebellar tent (tent);
absence / presence of formations (cyst, tumor, developmental anomaly, changes in the structure of the medulla, hematoma, fluid, etc.);
the state of the vascular bundles (normally they are hyperechoic).

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

Options	Norms for newborns	Norms in 3 months
Lateral ventricles of the brain	The front horns are 2-4 mm. The occipital horns are 10-15 mm. Body - up to 4 mm.	Front horns - up to 4 mm. The occipital horns are up to 15 mm. The body is 2-4 mm.
III ventricle	3-5 mm.	Up to 5 mm.
IV ventricle	Up to 4 mm.	Up to 4 mm.
Interhemispheric gap	3-4 mm.	3-4 mm.
Big cistern	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 abnormalities, etc. The decoding 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 by neurosonography

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

Choroid plexus cyst (do not require intervention, asymptomatic), usually there are several of them. These are small bubble formations in which there is a liquid - cerebrospinal fluid. Self-absorbing.
Cysts are subependymal. Formations containing liquid. They arise as a result of hemorrhage, can be 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). They require treatment, supervision of a neurologist and control. They can be located anywhere in the arachnoid membrane, they can grow, they are cavities containing fluid. Self-absorption does not occur.
Hydrocephalus / dropsy of the brain is a lesion resulting in the expansion of the ventricles of the brain, as a result of which fluid accumulates in them. This condition requires treatment, monitoring, and control of the NSH over the course of the disease.
Ischemic lesions also require compulsory therapy and control studies in dynamics with the help of NSH.
Hematomas of the brain tissue, hemorrhages in the space of the ventricles. Diagnosed in premature babies. In full-term babies, this is an alarming symptom and requires mandatory treatment, control and observation.
Hypertensive 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 babies and babies born at term. This happens under the influence of foreign formations - cysts, tumors, hematomas. However, in most cases, this syndrome is associated with an excess amount of accumulated fluid (cerebrospinal fluid) in the space of the brain.

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

Post date: 06.12.2011 11:40

vika

Hello! Please tell me what these data say Subarachnoid space 2mm. interhemispheric gap 6mm. Ventricular system, all parameters by 3mm. The cistern in the sagittal plane is 2.6mm. Doppler sonography: PMA RI 0/54? OA-RI 0.52. Vienna Galena speed 12 cm per second.
Is it worth taking asparkam for vitamin D deficiencies.

Post date: 06.12.2011 21:29

Papkina E.F.

Vic, the expansion of the interhemispheric gap is a sign of fluid accumulation between the cerebral hemispheres. 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.
With a lack of vitamin D, vitamin D3 or other drugs (vigontol, fish oil) are prescribed, but asparks are not needed in this case.

Post date: 12.03.2012 16:42

a guest

Hello! Please explain, we were diagnosed with mild dilation of the lateral ventricular bodies, is it very scary?

Post date: 13.03.2012 21:08

Papkina E.F.

Mild dilation of the lateral ventricular bodies 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. Uzist said that there is some expansion of the interhemispheric fissure. We are 4 months old - Sharina interhemispheric gap 8mm. What is the threat? very worried

Post date: 05.05.2012 22:14

Papkina E.F.

Irina, isolated expansion 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 gap should it be treated or can we get by with a massage?

Post date: 07.07.2012 20:31

Papkina E.F.

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

Post date: 21.08.2012 13:00

a guest

We are 6 months old, the inter-hemispheric gap is 6mm, is it dangerous and does it need to be treated somehow, the neurologist said it is possible to drink lingonberries, is that so?

Post date: 23.08.2012 21:59

Papkina E.F.

With the normal development of the child, this is not dangerous.

Post date: 02.09.2012 22:38

a guest

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

Post date: 05.09.2012 22:03

Papkina E.F.

According to ultrasound data - manifestations of intracranial hypertension. Consult a neurologist, he will check the compliance of reflexes and development of the child with his age. In case of deviations, treatment is required.

Post date: 05.09.2012 22:32

a guest

Many thanks!

Post date: 19.09.2012 11:02

yulia

Good day! The child underwent an ultrasound scan of the brain. We are 9 months old, msc 8mm, Front horns vs 4.6 vd 4.6 Occipital horns 15.8 and 16.3. third ventricle 4.1 Cistena magna slit-shaped. Subarachnoid space to the right 6.3 to the left 6.3. The blood flow velocity in the vein of Galen 10.6 (it was more decreased). The child is developing well, there are no deviations. Decipher please. Uzi did 8 times. Drank diacarb, there was a tank 6 * 12, it closed and the mpsch increased (it was 5mm) They said to drink diacarb again. Is this correct, if outwardly we were told everything is fine with him, if the ultrasound is not the norm. Thank you in advance

Post date: 24.09.2012 21:29

Papkina E.F.

Julia, if there are no deviations in the development of the child, then on the basis of the expansion of the MPS only, treatment is not indicated.

Post date: 26.09.2012 09:54

Yulia

Thank you very much for your answer! and it is possible one more question to us noticed that the subarachoidal space is enlarged to the right 6.3 to the left 6.3. It doesn't require treatment. And what it means.

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 convolutions. Treatment is required only if the child lags 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 figure of the convolutions is differentiated. The subarachnoid space is enlarged - 6 mm. The interhemispheric fissure is widened -6.2 mm. The cavity of the transparent septum is 3.5. Lateral ventricles: The depth of the anterior horns right-5 left-5, the depth of the bodies right -8, left -7, the width of the occipital horns right -13 left -14. The choroid plexuses of the lateral ventricles are homogeneous. The width of the 3 ventricles is -3. Depth of the 4th ventricle -3. Large tank -5. Subcortical ganglia: echogenicity, echo structure on the right and left - b / o, Periventricular area: echogenicity, echo structure on the right and left - b / o. Please tell me what this all means? What are the consequences? What to do at all. Nothing like that can be seen in the child; Very worried. Thanks a lot in advance.

Post date: 03.10.2012 21:12

Guzel

Hello! My baby is 8 months old. They did an ultrasound of the brain. The interhemispheric gap is widened to 3-4 mm in all. At 7 months, there were febrile convulsions that lasted 4 minutes. and never repeated. The doctor prescribed Picamilon, Vintocetin and Cortexin injections. She also prescribed a long-term administration of Depakin. I read the instructions of the drugs and was horrified by the side effects. Is the child's condition so dangerous and is it worth taking these drugs? The child is very active and develops normally. Thank you in advance!

Antipyretics for children are prescribed by a pediatrician. But there are emergency situations for fever in which the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to be given to infants? How can you bring down the temperature in older children? What are the safest medicines?

How well all the organs and their systems are developed in a child by the time of birth depends on how he will adapt to life in the future and what his health will be. It is for this reason that it is important to timely identify all existing deviations and, if possible, eliminate them.

The size of the interhemispheric gap is individual for each baby, but it should not exceed three millimeters.

Among the most accurate diagnostic procedures for the brain for children under one year old is neurosonography ... The procedure has been known since the nineties of the last century.

This is the same ultrasound, and the fontanelles, which every baby has, allow the ability to explore the intracranial space. The sensor is lubricated with a special gel that provides better glide over the baby's head, and is applied to these natural holes in the baby.

Ultrasound can determine serious pathologies of the brain or exclude them, and also answer the question of why the interhemispheric gap is enlarged. This research is inexpensive, very simple, does not require special training, but it is quite informative. It makes it possible to identify even those violations that have arisen in the prenatal period.

An increase in the gap between the hemispheres and the subarachnoid space in an infant: causes and consequences

The main reasons for the expansion of the interhemispheric fissure and subarachnoid cavity are:

mother's ailments during pregnancy;
surgical delivery (caesarean section);
accumulation of fluid between the hemispheres of the brain.

In the event of an expansion of this gap, the baby must be monitored: it is important to monitor whether it increases even more.

An urgent consultation with a pediatric neuropathologist is required if the child also has:

The widening of the gap between the hemispheres and the subarachnoid space is not an independent disease, but only a symptom of certain neurological pathologies, such as hydrocephalus (increased fluid content in the interventricular space) or intracranial hypertension.

Brain abnormalities, hemorrhages, cysts and brain tumors can also be found.

Not all of these diagnoses are dangerous, but children with the identification of such symptoms should be constantly monitored. .

A cyst in the brain of an infant is nothing more than a small bubble that is filled with fluid. Such a baby does not need treatment, but the growth of these cysts must be monitored.

Doctors are often alarmed by the size of the head above average. But this does not mean at all that every such child will have a serious pathology. Large head sizes can be associated with many reasons. For example, many parameters in our body are associated with heredity. If dad, mom or closest relatives wear a size 60 hat, then why can't a child have a head circumference larger than most of his peers.

The subrachnoid space is the cavity between the meninges of the brain and spinal cord. This cavity contains cerebrospinal fluid and cerebrospinal fluid. Normally, it contains about 140 ml of cerebrospinal fluid, flowing from the fourth ventricle of the brain of the head through special holes.

The subarachnoid cavity expands in parallel with the head circumference. At the same time, the fontanelles protrude, the timing of their overgrowth is delayed. If there is a local expansion of this space, then this means that the circulation of the cerebrospinal fluid is impaired.

If such abnormalities are found in a child with an enlarged interhemispheric gap, do not immediately panic. Most small deviations in babies mean absolutely nothing, because the child's brain is actively developing during this period. If the conclusions of a specialist seem doubtful, an ultrasound examination should be performed again in another clinic, where these conclusions will either be confirmed or refuted.

Pediatric neurology is a fairly young science, which is now constantly faced with problems of various complexity. This is both a lack of high-quality equipment and a shortage of well-trained specialists. Despite this, one should not take any of the doctor's conclusions with hostility, because this is nothing more than an opportunity to make sure of the full health of your child, and, possibly, to start the necessary therapy on time.

In order to timely identify the pathology, infants are constantly under the supervision of a local pediatrician. At certain stages of their development, babies under one year old should be consulted by various specialists several times.

This list also includes a pediatric neurologist who should be seen at one, three, six and twelve months. You should not neglect these consultations, so as not to reproach yourself later. Suspicions of a brain tumor and intracranial hypertension require immediate hospitalization, serious examination, and long-term treatment. Fortunately, most of the suspicions of neurologists, more often than not, remain suspicions, but their instructions should not be ignored.

More about neurosonography and other methods for diagnosing such a pathology

Neurosonography lasts no more than fifteen minutes, babies usually tolerate it well. Some children may oversleep the entire procedure, which does not interfere with its implementation at all. But there are very capricious crumbs that you cannot force to lie still for even a minute, they can be irritated by a sensor, a new environment, or even a doctor conducting a study. In this case, you need to take a pacifier, bottle with drink or favorite toy with you. Ultrasound examination is good because it is not tied to food intake, because it is known that some children cannot be made to endure several hours without food and drink.

Another advantage of this procedure is that the baby is not taken away from the mother. She can be nearby and even ask the doctor questions of interest to her. Sometimes a specialist needs to clarify something, for example, about how the pregnancy proceeded, what the mother was sick with before giving birth or the baby was sick throughout her life. He can learn all the necessary information from his mother, so her presence during neurosonography is simply necessary.

You can do this research from the first day of life. ... The data is deciphered by a pediatrician or pediatric neurologist. Only a specialist can link the research data with the existing clinic and make a diagnosis.

If serious abnormalities are identified, sometimes it is necessary to resort to examinations such as magnetic resonance imaging and computed tomography. These techniques are expensive and take much longer, so they are performed only after dubious or alarming neurosonography results.

MRI is by far the most accurate of all known studies. With its help, you can see a layered image of the desired area. But it is very difficult to examine infants in this way: during the procedure, you need to lie still, but how can this be required from a child under one year old? But there are times when this research is indispensable. If there is a serious need for an MRI, the baby will have to be given anesthesia.

Treatment methods

With a slight expansion, treatment is not carried out, but it is still necessary to examine the child periodically. If, during diagnostic procedures, fluid accumulation is found in the subarachnoid cavity, treatment is prescribed.

Usually, the list of prescribed funds includes:

substances that promote the removal of excess fluid from the body;
potassium and magnesium-containing preparations;
b vitamins;
vitamin D3, if it turns out that there is not enough of it in the body.

If a strong and progressive increase in the subarachnoid cavity is found, then all therapy consists in eliminating the cause that caused this violation. If intracranial pressure is increased, then drugs are prescribed to reduce it (diuretics). If an infection has led to a pathology, then a small patient is prescribed a course of antibiotic treatment.

hydrocephalus

If a baby has hydrocephalus without a significant increase in the ventricles and the head as a whole, it should be remembered that in four out of five cases, it can compensate itself by two years. But you should not rely too much on this opinion, and if in several clinics this diagnosis was confirmed by ultrasound, then it is better to undergo the necessary treatment.

Hydrocephalus is dangerous because if the head has greatly increased under the pressure of the fluid, then its size will not return to normal even after surgical treatment. Vision may also decrease up to blindness, the child may lag behind in development, speech and other important functions of the body may be impaired.

If, during the treatment of this formidable ailment, then its outcome is quite favorable.

Thus, if a child has an enlarged gap between the hemispheres, but he develops normally, sleeps calmly, and is not too restless, most likely there is no reason for worry. But doctor's advice should not be neglected.

Post date: 06.12.2011 11:40

vika

Post date: 06.12.2011 21:29

Papkina E.F.

Post date: 12.03.2012 16:42

a guest

Hello! Please explain, we were diagnosed with mild dilation of the lateral ventricular bodies, is it very scary?

Post date: 13.03.2012 21:08

Papkina E.F.

Mild dilation of the lateral ventricular bodies does not require therapy and is not dangerous for the child.

Post date: 04.05.2012 18:02

Irina

Post date: 05.05.2012 22:14

Papkina E.F.

Irina, isolated expansion 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 gap should it be treated or can we get by with a massage?

Post date: 07.07.2012 20:31

Papkina E.F.

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

Post date: 21.08.2012 13:00

a guest

We are 6 months old, the inter-hemispheric gap is 6mm, is it dangerous and does it need to be treated somehow, the neurologist said it is possible to drink lingonberries, is that so?

Post date: 23.08.2012 21:59

Papkina E.F.

With the normal development of the child, this is not dangerous.

Post date: 02.09.2012 22:38

a guest

Post date: 05.09.2012 22:03

Papkina E.F.

Post date: 05.09.2012 22:32

a guest

Many thanks!

Post date: 19.09.2012 11:02

yulia

Post date: 24.09.2012 21:29

Papkina E.F.

Julia, if there are no deviations in the development of the child, then on the basis of the expansion of the MPS only, treatment is not indicated.

Post date: 26.09.2012 09:54

Yulia

Post date: 26.09.2012 19:36

Papkina E.F.

Post date: 29.09.2012 05:08

Angelica

Post date: 03.10.2012 21:12

Guzel

Keywords: perinatal encephalopathy (PEP) or perinatal damage to the central nervous system (PN CNS), hypertensive-hydrocephalic syndrome (HGS); expansion of the ventricles of the brain, interhemispheric fissure and subarachnoid spaces, pseudocysts on neurosonography (NSG), muscular dystonia syndrome (MDS), hyperexcitability syndrome, perinatal convulsions.

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

Pediatric neurology is a relatively recent birth, but it is already going through difficult times. At the moment, many doctors practicing in the field of neurology of infancy, 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 an overdiagnosis 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 neuropsychiatric symptoms, ignorance of general pediatrics and the foundations of medical psychology, some therapeutic nihilism and fear of using the potential of modern drug therapy; and the result is wasted time and missed opportunities. At the same time, unfortunately, a certain (and sometimes significant) "formality" and "automaticity" of modern medical technologies lead, at least, 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 down, now it is intensively and not always justifiably expanded. Probably the truth is somewhere in between ...

According to the clinic of perinatal neurology of the medical center "NEURO-MED" and other leading medical centers in Moscow (and probably in other places), so far, more 80%!!! children of the first year of life come in the direction of a pediatrician or neuropathologist from the district clinic for a consultation about non-existent diagnosis - perinatal encephalopathy (PEP):

The diagnosis of "perinatal encephalopathy" (PEP) in Soviet pediatric neurology very vaguely characterized almost any dysfunctions (and even structures) of the brain in the perinatal period of a child's life (from about 7 months of intrauterine development of a child to 1 month of life after childbirth), arising from pathology 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 disorder of the nervous system, for example, hypertensive-hydrocephalic syndrome (HGS), muscular dystonia syndrome (MDS), hyperexcitability syndrome.

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

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

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

Until now, the diagnosis is "intracranial hypertension" (increased intracranial pressure ( ICP)), one of the most common and "favorite" medical terms among pediatric neurologists and pediatricians, to whom almost everything can be explained! and at any age, parental complaints.

For example, a child often cries and shudders, sleeps poorly, spits up a lot, eats poorly and gains little weight, goggles, walks on tiptoes, his hands and chin tremble, there are convulsions and there is a lag in psycho-speech and motor development: “only it is to blame - increased intracranial pressure ”. A convenient diagnosis, isn't it?

Quite often, “heavy artillery” - data from instrumental diagnostic methods with mysterious scientific graphs and numbers - is used as the main argument for parents. Methods can be used either completely outdated and uninformative / echoencephalography ( ECHO-EG) and rheoencephalography ( REG) /, or surveys "not from that opera" ( EEG), or an incorrect, in isolation from clinical manifestations, subjective interpretation of the normal variants in neurosonodopplerography or tomography.

Unhappy mothers of such children unwittingly, at the suggestion of doctors (or willingly, feeding on their own anxiety and fears), pick up the flag of "intracranial hypertension" and for a long time fall into the system of observation and treatment of perinatal encephalopathy.

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

Hospitalization is obligatory and urgent!!

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

A very serious symptom can be squint or pupillary difference, and, of course, impaired consciousness. In infants, bulging and tension of the fontanelle, divergence of the seams between the bones of the skull, and 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 pre-diagnose this pathology. Sometimes it requires additional research methods (fundus, neurosonodopplerography, computed or magnetic resonance imaging of the brain)

Of course, the expansion of the interhemispheric gap, the ventricles of the brain, the subarachnoid and other spaces of the cerebrospinal fluid system on neurosonography (NSG) or brain tomograms (CT or MRI) cannot serve as evidence of intracranial hypertension. The same applies to disorders of cerebral blood flow, isolated from the clinic, revealed by Doppler ultrasonography of the vessels, and "digital impressions" on the X-ray of the skull

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

That is why, if your baby was diagnosed with AED, intracranial hypertension, based on the “goggle” of the eye (a symptom of Graefe, the “setting sun”) and walking on tiptoes, then you should not go crazy in advance. In fact, these reactions can be characteristic of highly excitable young children. They react very emotionally to everything that surrounds them and what is happening. Attentive parents will easily notice these relationships.

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

It is absolutely unreasonable to start treatment of this serious pathology on the recommendations of one doctor on the basis of the above "arguments", besides, such unreasonable treatment is not at all safe.

That there are only diuretics 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 considered in this situation. Sometimes medications are necessary and an unlawful refusal from them, on the basis of only the mother's (and more often the father's!) Own belief in drug harm, 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 surgery (bypass surgery) and the development of severe irreversible consequences for the child: hydrocephalus, developmental disorders, blindness , deafness, etc.

Now a few words about no less "adored" hydrocephalusand 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 one! at that moment intracranial hypertension. In this case, neurosonograms (NSG) or tomograms reveal the expansion of the ventricles of the brain, the interhemispheric fissure and other parts of the cerebrospinal fluid system that changes over time. It all depends on the severity and dynamics of symptoms, and most importantly, on the correct assessment of the relationship between the increase in intracerebral spaces and other nervous changes. This can be easily determined by a trained neurologist. True hydrocephalus, which does require treatment, as is intracranial hypertension, is relatively rare. Such children must be monitored by neurologists and neurosurgeons of 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 insignificant) increase in the ventricles and other cerebrospinal fluid spaces as hydrocephalus (hydrocephalic syndrome). This does not manifest itself by external signs and complaints, and does not require treatment. Moreover, if the child is suspected of hydrocephalus on the basis of the "big" head, translucent vessels on the face and scalp, etc. - this should not cause panic among the parents. The large size of the head in this case plays almost no role. However, the dynamics of head circumference growth is very important. In addition, you need to know that among modern children, so-called "tadpoles" are not uncommon, in which the head is relatively large for their age (macrocephaly). In most of these cases, babies with large heads show signs of rickets, less often - macrocephaly, due to the family constitution. For example, dad or mom, or maybe grandfather has a big head, in a word, it is a family matter and does not require treatment.

Sometimes, during neurosonography, the ultrasound diagnostics doctor finds in the brain pseudocysts - but this is not at all a reason for panic! Pseudocysts are single rounded tiny formations (cavities) containing cerebrospinal fluid and located in typical areas of the brain. The reasons for their appearance, as a rule, are not known for certain; 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. Nevertheless, although quite rarely, pseudocysts form at the site of subependymal hemorrhage, or are associated with previous perinatal cerebral ischemia or intrauterine infection. The number, size, structure and location of cysts provide specialists with very important information, taking into account which, on the basis of a clinical examination, final conclusions are formed.

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

Most often, NSG data give 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 the parents (less often - and 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 there is a suspicion of increased intracranial pressure and hydrocephalus, the 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"? - probably, you just did not go with your baby to a neurologist at the clinic for up to a year. This is, of course, a joke. However, the diagnosis of "muscular dystonia" occurs no less often (and perhaps more often) than hydrocephalic syndrome and increased intracranial pressure.

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

Briefly about the external signs of changes in muscle tone.

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

Muscular dystoniacharacterized by a condition when 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 hands than in the legs, more on the right than on the left, etc.)

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

Muscular hypertension is characterized by an increase in resistance to passive movements and a limitation of spontaneous and voluntary motor activity. Severe muscle hypertension can also significantly affect the pace 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 a change in muscle tone is not only associated with neurological disorders, but also strongly depends 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 requires 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 exercise therapy (exercises on large balls are very effective). Medication is rarely prescribed.

Hyperexcitability syndrome

(syndrome of increased neuro-reflex excitability)

Frequent crying and whims with or without, emotional instability and increased sensitivity to external stimuli, disturbed sleep and appetite, profuse frequent regurgitation, motor restlessness and flinching, trembling of the chin and arms (etc.), often in combination with poor weight gain weight and stool disorders - do you recognize such a child?

All motor, sensory and emotional reactions to external stimuli in a hyperexcitable child arise intensely and abruptly, and can fade just as quickly. Having mastered these or those motor skills, children continuously move, change positions, constantly reach for some objects and grab them. Usually children show a keen interest in their surroundings, but increased emotional lability often complicates their contact with others. They are very impressionable, emotional and vulnerable! They fall asleep extremely badly, only with their mother, they constantly wake up, cry in their sleep. Many of them have a long-term fear reaction to communication with unfamiliar adults with active protest reactions. Usually the syndrome of hyperexcitability is combined with increased mental exhaustion.

The presence of such manifestations in a child is just a reason for contacting a neurologist, but in no case is it a reason for parental panic, and even more so for drug treatment.

Constant hyperexcitability in a causal relation is not very specific and can most often be observed in children with peculiarities of temperament (for example, the so-called choleric type of response).

Much less often, hyperexcitability can be associated and explained by the perinatal pathology of the central nervous system. In addition, if the child's behavior suddenly and unexpectedly and for a long time was disturbed for almost no apparent reason, he developed hyperexcitability, the likelihood of developing a reaction of adaptation disorder (adaptation to external environmental conditions) due to stress cannot be excluded. And the sooner the specialists look at the child, the easier and faster it is to cope with the problem.

And finally, most often, transient hyperexcitability is associated with pediatric problems (rickets, impaired digestion and intestinal colic, hernias, teething, etc.).

There are two extremes in the tactics of monitoring these children. Or the “explanation” of hyperexcitability with the help of “intracranial hypertension” and strenuous drug treatment using often drugs with serious side effects (diacarb, phenobarbital, etc.). Or complete neglect of the problem, which can lead in the future to the formation of persistent neurotic disorders (fears, tics, stuttering, anxiety disorders, obsessions, sleep disturbances) 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 ...

I would also like to draw the attention of parents to convulsions is one of the few disorders of the nervous system that really deserves close attention and serious treatment. Epileptic seizures are not common in infancy, but sometimes they are difficult, insidious and disguised, and immediate medical therapy is almost always necessary.

Such seizures can be hidden behind any stereotyped and repetitive episodes in the child's behavior. Incomprehensible jerks, head nods, involuntary eye movements, "fading", "pinching", "limp", especially with stopping gaze and lack of reaction to external stimuli, should alert parents and force them to turn to specialists. Otherwise, a late diagnosis and an untimely prescribed drug therapy significantly reduce the chances of treatment success.

All the circumstances of the episode of seizures must be accurately and completely remembered and, if possible, recorded on video for further detailed story at the consultation. If the convulsions last for a long time or are repeated - call "03" and urgent consultation with a doctor.

At an early age, the child's condition is extremely changeable, therefore, 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 have been determined for routine consultations of a pediatric neurologist in the first year of life: usually at 1, 3, 6 and 12 months. It is during these periods that most serious diseases of the nervous system of children of the first year of life can be detected (hydrocephalus, epilepsy, cerebral palsy, metabolic disorders, etc.). Thus, the identification of a specific neurological pathology at the early stages of development makes it possible to start complex therapy on time and at the same time achieve the maximum possible result.

And in conclusion, I would like to remind parents: be empathetic and attentive to your kids! First of all, it is your meaningful participation in the lives of children that is the basis for their further well-being. Do not heal them for "alleged illnesses", but if something worries or worries you, find an opportunity to get independent advice from a qualified specialist.

Post date: 27.10.2011 08:23

ksyusha

HELLO! MY SON IS 2 MONTHS. HYPOXIA WAS DURING THE BIRTH. DEVELOPS NORMALLY. BUT THE USE SHOWED AN INTERHEMESAL FISSION DISPENSED 0.56 (IN NORMAL UP TO 0.4). NOT DISPLACED.

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 gap is more than normal. Grew and developed according to age. We had small problems with speech. We worked with a speech therapist. Soon we are seven years old. Calm and intelligent boy. Very creative. DO NOT EXPERIENCE ANYTHING SCARY!

Post date: 27.10.2011 20:26

Papkina E.F.

Ksyusha, a slight expansion of the interhemispheric gap is not dangerous for a child's development.

Post date: 28.10.2011 02:43

ksyusha

oh thank you very much! you reassured me, otherwise it is difficult to find a good specialist with us, but we ourselves are not competent in matters of medicine at all. I forgot to say that we still do not hold our heads well. Sometimes I am too lazy to raise it. When it lies on my stomach, it lifts it well. But on the bed it is bad and not always upright. Doctors say that he should already keep it well at 2 months. We have 41 cm, at birth it was 36. Please comment.

Post date: 28.10.2011 22:17

Papkina E.F.

Ksyusha, head growth in 2 months-4 cm, this is normal. For uncertain head holding, it is necessary to regularly, 8-10 times a day, lay the baby on his stomach on a hard surface before feeding. In addition, exercises on an inflatable ball (putting the baby tummy on the ball and roll. Well strengthens muscle tone also a course of general tonic massage.

Post date: 29.10.2011 01:36

ksyusha

thank you again. We will definitely buy a ball and use the rest of the recommendations. Health to you!

Post date: 15.05.2012 16:14

yulia

please tell me, my son had an ultrasound scan of his head for 4.5 months, and we were told that he had a m / n gap of 6mm, at a rate of 5mm, how should we be in this situation, it is necessary to treat it somehow ... and they also advised to make control in speakers .. thanks for your reply.

Post date: 17.05.2012 22:06

Papkina E.F.

Julia, if there are no other changes in the ultrasound scan and in the development of the child, then a small expansion of the MPS is not dangerous.

Post date: 31.05.2012 05:51

Tatyana

Hello, we have an extension all the way up to 2.4 mm, we are 2 months old, should you worry about this?

Post date: 03.06.2012 22:05

Papkina E.F.

Tatyana, this is the norm.

Post date: 06.06.2012 18:34

a guest

Hello! my son is 1.5 months old, in the maternity hospital there was a chin trimmer while crying, we got magnesia pierced, everything went away. after discharge, after 2 weeks, the same thing began, and in a calm state the child sometimes shakes his chin. At the first examination, the neurologist sent me for an ultrasound scan. the conclusion of the ultrasound showed the expansion of the MPSH and something else (it is illegible written there). the doctor prescribed treatment for asparkam, pantogam and hypothiazide for a month. having diagnosed us with intracranial pressure. tell me what is the expansion of the mpsch and is the pressure dangerous at this age ????

Post date: 27.07.2012 10:53

a guest

Hello! My son is 4 months old, the expansion of the MPSH is 5.0 mm, diastasis is hm / bone D 5.2 S 4.8 mm, the third ventricle is 3.8 mm. PRB Zh on the left 3.4mm on the right 4.3mm. The diagnosis was enlargement of the BEM, dimetaia of the PAD, expansion of the third ventricle. Impaired resorption. No treatment was prescribed. Control at 6-7 months. What to do??

Post date: 14.08.2012 10:12

Yulia

Good day! Our son is 3.5 months old, today an ultrasound of the brain was done, in the conclusion it is indicated that the expansion of the interhemispheric gap is 9mm. How can you get rid of this? What are the best treatments? thank

Post date: 18.08.2012 19:40

Papkina E.F.

Dear Parents! Expansion of the MPS and the 3rd ventricle is a manifestation of the transferred hypoxia and moderate intracranial hypertension. Treatment without examination is impossible, consult 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 gap \u003d 10.6 mm and intracranial pressure. At birth, og \u003d 36 cm, and at 2 months \u003d 42.5 cm, while height \u003d 60 cm, and weight \u003d 6065g We went to a neurologist, he prescribed us to drink Diacarb + Asparcam + Cavinton. Vaccinations were postponed for a month. With ultrasound, the ventricles are normal. The pediatrician said that we have all the indicators of growth, weight and og correspond to a 3-month-old baby. that childbirth was very difficult by an emergency caesarean section, there was hepoxia, the baby was born blue, but immediately screamed, on the Apgar scale-8/9 points. The baby is calm from birth, sleeps well at night, wakes up only to eat and continue to sleep, observes objects , walks, tries to get toys with his hands, holds his head, but the truth is not long. Please tell me how absurd is the deviation from the norm of the interhemispheric gap in our situation, and whether the doctor prescribed the treatment correctly and is it necessary at all? now 7 years old, viewer I took her card and in 1 month og \u003d 42cm, and they didn’t send us anywhere and we didn’t do any neurosonography, unlike the second child, she was restless, and nothing grew up a healthy girl and by the year the spring had healed. What should I do in this situation, I ask help? Thank you in advance!

However, looking at the sheet describing the results of an ultrasound scan, you involuntarily get scared when you see a lot of unfamiliar words and incomprehensible numbers standing next to it. What do they mean? The answer can be given by a competent specialist when deciphering the results, as well as a neurologist. One of the indicators that can be alarming is the expansion of the interhemispheric gap in the baby. How dangerous this condition is and whether it needs to be treated somehow - let's figure it out.

About the gap between the hemispheres

There is a gap between the cerebral hemispheres, the anatomical dimensions of which are on average up to 3 mm. But some of the children may have more - then in most cases they talk about the anatomical features of development.

Of course, if the interhemispheric gap is expanded, and besides, it is filled with fluid, this may indicate the development of diseases such as rickets, intracranial pressure, hydrocephalus. But the diagnosis is never made on the basis of only the data of the results of neurosonography. The clinical picture as a whole is taken into account.

The doctor may ask the following questions:

how the child sleeps, how many hours a day, at what interval he wakes up;
how often the baby spits up;
how restless his behavior is, are there any causeless tantrums lasting more than 5 minutes;
whether the baby reacts to changes in atmospheric pressure, whether sharp sounds frighten him, how things are with reflexes;
whether the baby has signs of rickets: enlarged fontanelle, large forehead, smooth nape (without hairs).

With the help of neurosonography, you can look into the brain of a child, however, it is important that the results are correctly decoded, otherwise the study loses its meaning

The dimensions of the head circumference are also taken into account (with their persistent increase, there are reasons to suspect the development of hydrocephalus), the condition of the skin (is there a marble pattern), how well the fontanelles are overgrown, whether there is strabismus or Graefe's symptom, when the eyes roll in such a way that the white of the eye is clearly visible ...

Reasons for increasing the gap

So, an enlarged gap in a baby, exceeding the so-called norm, can manifest itself as a hereditary feature transmitted from parents or close relatives.

It can also occur due to:

fetal hypoxia during pregnancy;
accumulation of fluid between the cerebral hemispheres;
birth injuries such as caesarean section or obstetric labor.

Do I need to treat

Often, mild expansion of the gap does not require any treatment.

Therapy is not carried out even in the case when an increase in the interhemispheric gap in an infant is the only disturbing factor.

When identifying symptoms accompanying the clinical picture of a disease, various groups of drugs can be prescribed.

For example, with signs of rickets and a newborn living in a climatic zone where there is little light, an additional intake of vitamin D is prescribed.

With symptoms of the development of intracranial pressure, special light diuretics are prescribed to facilitate the outflow of fluid from the brain structures. In parallel, Asparkam or Diacarb (potassium preparations) are taken to prevent the development of hypokalemia and hypomagnesemia.

The well-being of a child is one of the most important indicators of his health.

drugs that improve cerebral circulation, and a sedative at night. But this is only if there are warning signs that indicate neurological disorders.

It is worth noting that the baby's “bad sleep” itself is treated primarily not with drugs, but by normalizing the daily routine. It is very important that there are daily walks in the fresh air, and that the room where the child sleeps is cool and fresh. It is necessary to analyze how calm the atmosphere in the house is: whether there are frequent quarrels, the habit of listening to music loudly or watching horror films - all this can negatively affect the psyche of the baby.

So, if in the conclusion of an ultrasound of the brain it is noted that the interhemispheric gap in a child is enlarged, this is just a statement of the fact that it is wider than usual. The diagnosis of a specific disease is made not only on the basis of neurosonography, but also on the basis of specific complaints, real changes in behavior.

Expansion of the interhemispheric gap in infants

The correct and timely development of all organs in newborns is a guarantee of the child's health and normal adaptation in the future, therefore, at such a small age, it is important to diagnose all deviations in time and take measures to eliminate them.

In the article you will learn what the diagnosis of "expansion of the interhemispheric gap" means in a baby, for what reasons it happens.

When examining the brain of a newborn (ultrasound, neurosography, tomogram), in addition to detecting other pathologies, doctors look at the size of the interhemispheric gap. This distance is an anatomical feature of the baby, it is considered normal if it is less than 3 mm.

In infants, the interhemispheric gap can be expanded for reasons, including:

mother's illness during pregnancy;
caesarean section during childbirth;
fluid accumulates between the cerebral hemispheres.

You should immediately seek advice from a pediatric neuropathologist if you notice that the baby:

constantly agitated;
does not sleep well;
reacts to harsh sounds with a cry;
shows concern when atmospheric pressure changes.

The widening of the interhemispheric gap is only one of the signs of some serious disorders, therefore, when diagnosing, doctors analyze the relationship of this symptom with other clinically pronounced nervous changes. With a mild degree of expansion of the gap or isolated expansion, treatment is not carried out, since these conditions are safe for the child, in other cases it must be prescribed.

When fluid accumulates between the hemispheres of the brain, children in the complex are prescribed the following drugs:

preparations for the withdrawal of liquids;
asparcam, which is a source of K and Mg for the body;
vitamin D3, with a lack of vitamin D.

It should also be noted that the presence of an expansion of the interhemispheric gap in infants is not a basis for the diagnosis of intracranial hypertension.

Thus, if your baby has an enlarged interhemispheric gap, but at the same time he develops correctly and is healthy, then you do not need to worry and be nervous, the most important thing is to undergo scheduled examinations with doctors on time.

uziprosto.ru

Encyclopedia of Ultrasound and MRI

Expansion of the interhemispheric gap in an infant baby: what to do?

Interhemispheric gap in infants: rate of indicators, diagnostic methods

The size of the interhemispheric gap is individual for each baby, but it should not exceed three millimeters.

Among the most accurate diagnostic procedures concerning the brain for children under one year old is neurosonography. The procedure has been known since the nineties of the last century.

An increase in the gap between the hemispheres and the subarachnoid space in an infant: causes and consequences

The main reasons for the expansion of the interhemispheric fissure and subarachnoid cavity are:

mother's ailments during pregnancy;
surgical delivery (caesarean section);
accumulation of fluid between the hemispheres of the brain.

In the event of an expansion of this gap, the baby must be monitored: it is important to monitor whether it increases even more.

An urgent consultation with a pediatric neuropathologist is required if the child also has:

disturbed sleep;
constant excessive excitement;
frightened and screams from harsh sounds;
often vomits with a "fountain";
a very serious sign of a violation of the nervous system of an infant is strabismus and various pupils;
excessive increase in head circumference;
fontanelles protrude and slowly grow;
eyes roll out or roll up so that the white of the eye is visible;
there are cramps and frequent twitching of the chin and limbs;
nosebleeds;
marble patterns on the dermis;
becomes restless at changes in atmospheric pressure.

Strabismus and different pupils in a child, as a sign of an expansion of the interhemispheric gap

Brain abnormalities, hemorrhages, cysts and brain tumors can also be found.

Not all of these diagnoses are dangerous, but children with such symptoms should be constantly monitored.

A cyst in the brain of an infant is nothing more than a small bubble that is filled with fluid. Such a baby does not need treatment, but the growth of these cysts must be monitored.

The subrachnoid space is the cavity between the meninges of the brain and spinal cord. This cavity contains cerebrospinal fluid and cerebrospinal fluid. Normally, it contains about 140 ml of cerebrospinal fluid, flowing from the fourth ventricle of the brain of the head through special holes.

More about neurosonography and other methods for diagnosing such a pathology

You can do this research from the first day of life. Data decryption is carried out by a pediatrician or pediatric neurologist. Only a specialist can link the research data with the existing clinic and make a diagnosis.

Treatment methods

Usually, the list of prescribed funds includes:

substances that promote the removal of excess fluid from the body;
potassium and magnesium-containing preparations;
b vitamins;
vitamin D3, if it turns out that there is not enough of it in the body.

If, during the treatment of this formidable ailment, then its outcome is quite favorable.

Widened interhemispheric fissure

as the doctor told me, glycine removes the side effects of pantogam. but the child all the same behaved periodically inadequately, the dream went astray, became some kind of wild. We didn't drink until the end.

in the diagnosis there is hydrocephalus, but the doctor explained that it is as a symptom, we just have atrophy, and the void was filled with fluid ((((

and you also had such (by the type of nods?) depakin did not suit them, they have been taking keppra for three weeks there were no seizures now they appeared again (((

we just had a loss of consciousness with blue discoloration, it lasted about a minute. many problems pass in children by the age of one year, I really believe that it will pass with us, and I wish you that)))

has healed your gap ?? we have such a problem right now (((

yes everything is gone, everything is ok! and we wish you that.

do not remember when? thank! does not affect development?

i will definitely not say the last ultrasound was done at 8-9 months. It was also about 9-10 mm, then I fell behind the child and did not bathe, it develops normally and thank God! for many it happens, passes, the main thing is not to grow further!

Olga, hello. Although a lot of time has passed, I wanted to ask: how is your child developing? Are there any consequences of the expansion of ICP. We are now 6 months old, and we have a 7.5 mm mpsh.

the girls last week made us an ultrasound of the head, my lyalya spits up, but not often and not a lot by count, + cries in my sleep. Sometimes she gets scared when she wakes up and shakes her. That's because of my complaints, we have an ultrasound appointed, and in the hospital did everything ideally! We now have MCh3.2 at 9 months. In the frontal region, 9.9 x 14.3 mm. SAP 4 mm. in the frontal region. In conclusion: US is a picture of enlargement of the MS and SAP, more in the anterior sections. Tanakan 40 mg was prescribed. 1/4 t., 2 p -1 month Phenibut 0.25 1/4 t. 2p. -1 month in the absence of effect within 2 weeks, Diakarb 0.25 1/4 t. 1 time in the morning, Asparkam 1/4 t., 3 times - 3 days. To whom were these drugs prescribed as the child tolerates? although everything is individual after all, ... did the treatment help? I'm very worried about the baby

We also had an enlargement. In a month it was 5 mm. We took diacarb with asparkam. Now we are almost 5 months old, today they did a second ultrasound, the result was 5.6 mm. They again prescribed a course of treatment.

Ultrasound signs of expansion of the interhemispheric gap, lateral ventricles of the brain (

Comments

Hey! Yes, there were 3 neurologists, everyone said that there is no panic, and no treatment is required, mmm, the fontanel is normal, just watch for now and that's it

So they told us the same thing.

Well, we have nothing for now, but your child is restless himself?

It seems normal, not a brawler and does not really bother us.

Well, thank God, this is the main thing, in fact ..

We were born at 41 weeks, there was no hypoxia in childbirth ... where is it all from (the head grows proportionally ..

All these symptoms disappear by the year. If the child does not lag behind in development, Treatment, except for massage, is not required. control of ultrasound in six months should decrease. Do not give the child pills unnecessarily, there is nothing to heal him. I hope they gave you a medical treatment from vaccinations?

We went to do ultrasounds ourselves, they didn't do it for us at the clinic, like they did it in the maternity hospital, now at 3 months. Therefore, we'll just go to the doctor. And for a long time the challenge should be given?

It all goes away, but for a long time. Therefore, very often it makes no sense to do an ultrasound. In theory, they should give a challenge for up to a year, but in practice they do not give it, since they have coverage and a premium. It is better to write a refusal ourselves up to a year. When all goes away, decide with vaccinations.

Yes, damn it in the hospital we were not given this (((the doctor recommended to do it, maybe they suspected ICP .. about vaccinations, I heard that it really is not worth doing them .. Thank you!

in the younger, the expansion of the lateral ventricles was 10 mm (it was a year). Moreover, this is an accidental find - they did an ultrasound after it flew into the jamb with a running start - there was a hematoma all over the forehead. Before and after that, I and the doctors had no complaints about the child. So don't panic ahead of time.

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We also had an expansion of the MPShch to 4.5 mm, but we had a lot of things. Were cured, now they are healthy. Which is what I wish for you.

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If not treated, the consequences will be. I'm telling you this not as a neurologist, but as an ultrasound doctor

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Please tell me! the child is 3.5 months old, the neuropathologist sent for neurosonography, the conclusion is very frightening: Ventriculomegaly 1-2 degrees, Expansion of the interhemispheric gap, external subaro-idal pr-va (4.5 mm). The neuropathologist said there was still a cyst. Prescribed diacarb, asparkam and intramuscular injections, the next dose is only at 6 months, I am very worried, the child spits up, sometimes a lot, can react to the weather. Tell me, maybe someone came across this, how scary it is and what the consequences can be?

be sure to go to Karnaukhova. she is a good specialist. up to 7 months we saw her, the child was absolutely healthy. they say in vain that she supposedly prescribes expensive treatment for everyone. if the child is healthy, there are no complaints. I came to her with a whole sheet of questions. she explained everything in detail.

Facts and misconceptions in perinatal neurology

Key words: perinatal encephalopathy (PEP) or perinatal lesion of the central nervous system (PN CNS), hypertensive-hydrocephalic syndrome (HGS); expansion of the ventricles of the brain, interhemispheric fissure and subarachnoid spaces, pseudocysts on neurosonography (NSG), muscular dystonia syndrome (MDS), hyperexcitability syndrome, perinatal convulsions.

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

Pediatric neurology is a relatively recent birth, but it is already going through difficult times. At the moment, many doctors practicing in the field of neurology of infancy, 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 an overdiagnosis 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 neuropsychiatric symptoms, ignorance of general pediatrics and the foundations of medical psychology, some therapeutic nihilism and fear of using the potential of modern drug therapy; and the result is wasted time and missed opportunities. At the same time, unfortunately, a certain (and sometimes significant) "formality" and "automaticity" of modern medical technologies lead, at least, to the development of psychological problems in the child and his family members. The concept of “norm” in neuroscience at the end of the 20th century was sharply narrowed down, now it is intensively and not always justifiably expanded. Probably, the truth is somewhere in between.

According to the clinic of perinatal neurology of the medical center "NEVRO-MED" and other leading medical centers in Moscow (and probably in other places), still more than 80%. children of the first year of life come in the direction of a pediatrician or neuropathologist from a district clinic for a consultation about a non-existent diagnosis - perinatal encephalopathy (PEP):

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

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

Until now, the diagnosis "intracranial hypertension" (increased intracranial pressure (ICP)), one of the most common and "favorite" medical terms among pediatric neurologists and pediatricians, which can explain almost everything! and at any age, parental complaints.

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

Hospitalization is mandatory and urgent !!!

That there are only diuretics that are prescribed to children for a long time, which has an extremely adverse effect on the growing body, causing metabolic disorders.

Now a few words about 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 one! at that moment intracranial hypertension. In this case, neurosonograms (NSG) or tomograms reveal the expansion of the ventricles of the brain, the interhemispheric fissure and other parts of the cerebrospinal fluid system that changes over time. It all depends on the severity and dynamics of symptoms, and most importantly, on the correct assessment of the relationship between the increase in intracerebral spaces and other nervous changes. This can be easily determined by a trained neurologist. True hydrocephalus, which does require treatment, as is intracranial hypertension, is relatively rare. Such children must be monitored by neurologists and neurosurgeons of specialized medical centers.

Sometimes, during neurosonography, the ultrasound diagnostics doctor finds pseudocysts in the brain - but this is not a reason for panic! Pseudocysts are single rounded tiny formations (cavities) containing cerebrospinal fluid and located in typical areas of the brain. The reasons for their appearance, as a rule, are not known for certain; 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. Nevertheless, although quite rarely, pseudocysts form at the site of subependymal hemorrhage, or are associated with previous perinatal cerebral ischemia or intrauterine infection. The number, size, structure and location of cysts provide specialists with very important information, taking into account which, on the basis of a clinical examination, final conclusions are formed.

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

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

Undoubtedly, therefore, if there is a suspicion of increased intracranial pressure and hydrocephalus, the diagnosis should be carried out at the highest professional level.

What is muscle tone and why is it so "loved"?

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

Briefly about the external signs of changes in muscle tone.

Muscular hypotension is characterized by a decrease in resistance to passive movements and an increase in their volume. Spontaneous and voluntary physical activity may be limited, palpation of the muscles is somewhat reminiscent of "jelly or very soft dough." Severe muscular 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 is characterized by a condition when muscle hypotension alternates with hypertension, as well as a variant of disharmony and asymmetry of muscle tension in certain muscle groups (for example, more in the arms than in the legs, more on the right than on the left, etc.)

(syndrome of increased neuro-reflex excitability)

The presence of such manifestations in a child is just a reason for contacting a neurologist, but in no case is it a reason for parental panic, and even more so for drug treatment.

And finally, most often, transient hyperexcitability is associated with pediatric problems (rickets, impaired digestion and intestinal colic, hernias, teething, etc.).

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 are not common in infancy, but sometimes they are difficult, insidious and disguised, and immediate medical therapy is almost always necessary.

Ultrasound showed that the child has an enlarged interhemispheric gap

is there liquor in it? (water)

liquor is not water, it's blood! and if there’s some water, it’s more dangerous!

%) CSF is not blood. Th write that?

liquor is not water, it's blood!

liquor is not water, it's blood! and if there’s some water, it’s more dangerous!

cSF is not blood. Th write that?

CSF is a liquid medium circulating in the cavities of the ventricles of the brain, the cerebrospinal fluid pathways, the subarachnoid space of the brain and spinal cord. The total content of cerebrospinal fluid in the body ml.

a neurologist prescribed Diacarb + Asparkam 1 / 4tab 2 r per day according to the schedule 2 days we drink 3 breaks, the course is 1.5 months

Cavinton 1/4 tablet, course 1 month

the pills are good, it will definitely not be worse, definitely only a positive effect. 😉 I would treat

the pills are good, it certainly won't be worse

Dilated ventricles, interhemispheric fissure and other parts of the cerebrospinal fluid system on neurosonogram (NSG) or tomograms

Sleep and behavior disorders

Hyperactivity, attention deficit, bad habits

Disorders of mental, speech and motor development, poor academic performance

- "marble" skin pattern, including on the head

- "digital impressions" on the X-ray of the skull

Tremor (trembling) of the chin

Tiptoe walking

Hypokalemia, myasthenia gravis, convulsions, skin flushing, paresthesia, tinnitus, loss of appetite, metabolic acidosis, pruritus. With prolonged use - nephrourolithiasis, hematuria, glucosuria, hemolytic anemia, leukopenia, agranulocytosis, disorientation, impaired touch, drowsiness, nausea, vomiting, diarrhea, allergic reactions, paresthesia.

Nausea, vomiting, diarrhea, abdominal pain, ulceration of the gastrointestinal mucosa, bleeding from the gastrointestinal tract, flatulence, dry mouth; AV block, paradoxical reaction (increase in the number of extrasystoles), bradycardia, decrease in blood pressure; phlebitis, venous thrombosis, dyspnea, pruritus, hyporeflexia, dizziness, paresthesia; myasthenia gravis, asthenia, increased sweating. With rapid intravenous administration - hyperkalemia, hypermagnesemia. Overdose. Symptoms: hyperkalemia (muscle hypotonia, paresthesia of the extremities, slowing down of AV conduction, arrhythmias, cardiac arrest). Early clinical signs of hyperkalemia usually appear when serum K + concentration is more than 6 meq / l: sharpening of the T wave, disappearance of the U wave, decrease in the S-T segment, prolongation of the Q-T interval, expansion of the QRS complex. The more severe symptoms of hyperkalemia - muscle paralysis and cardiac arrest - develop at a K + concentration of 9-10 meq / L. Treatment: inside or in / in - NaCl solution; in / in ml of 5% dextrose solution (SED insulin per 1 liter); if necessary, hemodialysis and peritoneal dialysis.

Decrease in blood pressure. Rarely - tachycardia, extrasystole, slowing of intraventricular conduction. For parenteral administration: dizziness, fever, flushing of the facial skin, nausea, thrombophlebitis at the injection site.

Table of norms of ultrasound of the brain of an infant and transcript of neurosonography in children

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

Indications for neurosonography

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

fetal hypoxia;
asphyxia of newborns;
difficult labor (accelerated / prolonged, with the use of obstetric aid);
intrauterine fetal infection;
birth trauma of newborns;
infectious diseases of the mother during gestation;
rhesus conflict;
cesarean 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;
sinking / protrusion of the fontanel in newborn children;
suspicion of chromosomal abnormalities (according to a screening study during pregnancy).

Having a baby by caesarean section, despite its prevalence, is quite traumatic for an infant. Therefore, babies with such anamnesis are obliged to undergo NSG for early diagnosis of possible pathology.

Indications for ultrasound examination within a month:

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

In addition to the main reasons, which are serious pathological conditions, NSH is prescribed in the case when the child has a fever for more than a month and has no obvious reasons.

Preparation and method of conducting research

Neurosonography does not require preliminary preparation. A baby should not be hungry or thirsty. If the baby has fallen asleep, you do not need 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.

Normal NSG results and interpretation

symmetry of brain structures - symmetric / asymmetric;
visualization of grooves and convolutions (should be clearly visualized);
condition, shape and location of cerebellar structures (tentation);
the state of the cerebral sickle (thin hyperechoic streak);
presence / absence of fluid in the interhemispheric gap (fluid should be absent);
homogeneity / heterogeneity and symmetry / asymmetry of the ventricles;
the state of the cerebellar tent (tent);
absence / presence of formations (cyst, tumor, developmental anomaly, changes in the structure of the medulla, hematoma, fluid, etc.);
the state of the vascular bundles (normally they are hyperechoic).

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

The occipital horns are mm.

The occipital horns are up to 15 mm.

Pathologies detected by neurosonography

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

Choroid plexus cyst (do not require intervention, asymptomatic), usually there are several of them. These are small bubble formations in which there is a liquid - cerebrospinal fluid. Self-absorbing.
Cysts are subependymal. Formations containing liquid. They arise as a result of hemorrhage, can be 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). They require treatment, supervision of a neurologist and control. They can be located anywhere in the arachnoid membrane, they can grow, they are cavities containing fluid. Self-absorption does not occur.
Hydrocephalus / dropsy of the brain is a lesion resulting in the expansion of the ventricles of the brain, as a result of which fluid accumulates in them. This condition requires treatment, monitoring, and control of the NSH over the course of the disease.
Ischemic lesions also require compulsory therapy and control studies in dynamics with the help of NSH.
Hematomas of the brain tissue, hemorrhages in the space of the ventricles. Diagnosed in premature babies. In full-term babies, this is an alarming symptom and requires mandatory treatment, control and observation.
Hypertensive 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 babies and babies born at term. This happens under the influence of foreign formations - cysts, tumors, hematomas. However, in most cases, this syndrome is associated with an excess amount of accumulated fluid (cerebrospinal fluid) in the space of the brain.

correct appointment
Hello. Please tell me if the treatment was prescribed correctly. The child is now 3 months old, height 63, weight 6600. Was born with a weight of 3740, height 53 cm, 8-9 on the Apgar scale. At discharge, a diagnosis of second-degree bilateral IVH was made. The treatment was carried out: a course of Actovegin, massage, electrophoresis. At 3 Months, they made an NSG, here are the results: the pattern of the convolutions and grooves is not changed, the subarachnoid space is not dilated, the interhemispheric gap is dilated 7 mm, the lateral ventricles are dilated right anterior horns 4, body 6.8 / 18 posterior horns 10, left anterior horns 4.6 body 6.6 / 18 posterior horns 11, 3 ventricle 4.8, caudothalamic notch is not changed, vascular plexuses are not dilated even. Conclusion echo signs of mild dilatation of the lateral ventricles, expansion of the interhemispheric gap. Prescribed treatment with Diacarb + Asparcam for 1/3 -1 month 3 days after 3. Vinpocetine 0.005 ¼ 3 times 1 month. Cortexin 5 ml + novocaine 0.5 dilute to 2 ml / m 1.5 ml once a day for 10 days. Relaxing massage on limbs + ozokerite boots. The child lying on his stomach holds his head well. The column is not confident enough yet. rolls over from belly to back. From back to side. Agukaet, smiles, holds toys. Sleeps well. Thanks in advance for your reply

Anonymous question 25-01-2016

Expansion of the subarachnoid space and interhemispheric fissure

Hello! The child is 6 months old, weight 7300 with a height of 72cm, ogr 43.5cm, ogr 43.5cm. Born on time by cs (planned) 4150gr, 56cm, apgar 8 / 9b. Нсг in 1 month without pathology. Before the planned examination by a neurologist at 6 months, everything was fine. On examination: increased tone in the right leg, hydrocephalic features, direction to nsg. The child sleeps well, reaches for the toy, takes and holds, walks and laughs, turns over, sits at the support, does not vomit. Results of nsg: the interhemispheric fissure is widened by 2-4 mm, the subarachnoid space is enlarged, the fluid level is 4.5-7 mm, in the anterior regions up to 8 mm; in conclusion: in the projection of the basal ganglia on both sides hyperechoic areas. The diagnosis made by a neurologist: hypertensive-hydrocephalic syndrome. Prescribed a medicine with citral and picamilon20mg 1 / 4t 2r / d 1 month. Vaccinations have not been canceled. I am confused by picamilon (the instructions say that it is contraindicated in children under 3 years old). Please tell me how dangerous the baby's diagnosis is, or can he be re-examined and show the baby to another neurologist? And what about vaccinations. Thanks in advance for your reply!

Is the interhemispheric gap 6.4 criticism?
Good day! Help deal with the NSG and our grief neurologist. The child is 5 months old. Head circumference 42 cm. Chest circumference 44 cm. NSG data: subarachnoid space on the right - 4.9 mm; left - 5.2 mm interhemispheric gap - 6.4 mm; the lateral ventricles are not dilated, the right anterior horn is 3.4 mm; body 3.2mm; right rear horn 5.8 mm; left front horn - 3.4 mm; body 3.6 mm; back. left horn 5.8 mm; the pericular region is not changed, the third ventricle is 3.5 mm, the choroid plexus on the right is not dilated, on the left is not dilated, the brain parenchyma is normal; the figure of the convolutions is not changed. Please tell me how critical are the data on the NSG? Is drug treatment required? The child is not worried about anything, he sleeps well, for 14-16 hours a day. At night he wakes up 1 time to drink some water.

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