Ventricular Width Research Articles

Fetal lateral ventricular ratio determination during the second trimester.

Ventriculomegaly may be diagnosed sonographically by identifying abnormal ventricular size. The lateral ventricular ratio (LVR) is a useful index in differentiating normal-sized ventricles from ventriculomegaly. The purpose of this study was to validate previously reported data establishing the normal range for LVR during the second trimester. Prior to 24 weeks, the diagnosis of ventriculomegaly may be difficult since the LVR normal range is quite large. The LVRs for 122 normal fetal ultrasound examinations were calculated based on measurements obtained by three observers. Data were obtained for fetuses during each week of gestation from 15 to 25 weeks. Lateral ventricular ratios varied from 56 +/- 18 per cent (mean +/- 2 standard deviations) at 15 weeks to 33 +/- 4 per cent at 25 weeks. The lateral ventricular width (LVW) range for normal fetuses was 0.7 to 1.1 cm as compared with a LVW range of 1.1 to 2.7 cm for 16 fetuses with hydrocephalus diagnosed during the second trimester. In conclusion, the LVR is extremely useful in differentiating ventriculomegaly from normal ventricular size. Serial ultrasound examinations are often mandatory in the second trimester in order to definitely identify ventriculomegaly. In addition, normal ventricular size may be verified with a LVW of less than 1.1 cm.

Ventricular size in newborn infants.

Cranial ultrasound examinations were performed on 533 infants of between 48 and 96 hours of age to establish the range of ventricular size in neonates of different gestational ages in whom there was no evidence of intraventricular hemorrhage or neural tube defects. It was found that ventricular size did not vary in infants with gestational age of 26 weeks or more. Only 15 (2.8 per cent) neonates had a ventricular width of greater than 3 mm. Of these 15 infants, 13 were re-examined within the first year of life and found to be neurologically and developmentally normal.

Intraventricular haemorrhage.

ABSTRACTNeonatal echoencephalography is performed routinely in all very low birth‐weight neonates in many nurseries throughout the world. The diagnosis of a haemorrhage requires the differentiation of normal echogenic periventricular structures from haemorrhage. A classification of haemorrhage based on size alone is advocated. A separate classification is then used to assess post‐haemorrhagic ventricular dilatation by measurement of “ventricular width”. As the long term neurodevelopmental outcome of the neonate is likely to be more related to the state of the brain parenchyma than the ventricles, the limitations of ultrasound in assessing the parenchyma has resulted in other techniques being investigated to determine if they can better predict subsequent handicap.

Ultrasound investigation of the fetal cerebral ventricles.

Significant recent advances in ultrasonic technology have now made possible detailed evaluation of normal and abnormal fetal intracranial anatomy. Accurate knowledge of fetal intracranial anatomy is important for accurate and reproducible cephalometry as well as in antenatal diagnosis of dilated brain ventricles. High resolution real-time ultrasonic investigation was performed in 280 normal obstetric patients from the 14th to the 41st weeks of pregnancy. Eight patients with antenatally detected hydrocephalic fetuses were also included in the study. Measurements of the ratio between lateral ventricular width and cerebral hemispheric width (LVW/HW) showed value at 0.61 of the 14th week to 0.29 at about the 27th week. This value then remains unchanged until term. Accordingly the LVW/HW ratio decreases as the fetus grows reflecting the developmental changes. Due to this simple measurement technique, it is possible to diagnose hydrocephaly much earlier than by means of the identification of an abnormal BPD growth or a discrepancy between head and abdomen circumferences. Although the earliest reported cases of prenatal ultrasound detection of hydrocephaly have been at 17-18 weeks, one must be very careful when making the diagnosis prior to 20 weeks because the lateral ventricles are usually disproportionally large at this time and the LVW/HW ratio is, therefore, high. Moreover, the normal range is rather wide at this age. For this reason it is useful to repeat the ultrasound examination after one week; if the ratio increases, the diagnosis of hydrocephaly can be made without any doubt.

Ultrasound evaluation of experimental hydrocephalus in dogs.

The use of real time ultrasound to evaluate experimental hydrocephalus in craniectomized dogs is described. Fifteen dogs were longitudinally evaluated by ultrasound after injection of silicone into the suprasellar cistern and injection of kaolin into the cisterna magna, and later killed. Ventricular size was classified as normal, moderately or severely hydrocephalic according to lateral ventricular width. In 93% (14/15) of the animals the classifications as determined by ultrasound and pathological examination agreed. Both lateral ventricular width and biventricular width as measured by ultrasound had a linear correlation with measurements on the pathologic specimens (p less than 0.001).

The wavering midline: A diagnostic sign of fetal hydrocephalus

The significance of midline wavering in the central nervous system as a diagnostic sign in hydrocephalus was evaluated prospectively in 27 hydrocephalic fetuses. No normal fetuses in a control group exhibited a wavering midline at three different times in pregnancy. Wavering along the entire length of the midline was seen in all 27 affected infants with hydrocephalus diagnosed from 12 to 42 weeks' gestation, prior to determination of an abnormal lateral ventricular width: hemispheric width ratio in one of 23 cases for which data were available and prior to an increased biparietal diameter in 25 (48%). One fetus, not included in the series, showed wavering of the midline echo and had an abnormal lateral ventricular width: hemispheric width ratio. The neonate was later shown to have trisomy 21 (47,XY,+21) and is suspected to have had a transient ventriculomegaly. Wavering along the complete length of the midline echo appears to be a constant finding in hydrocephalus in the fetus.

The alcoholic brain: CT scan and psychological findings.

One hundred male alcoholics without overt clinical signs of brain damage were interviewed, psychologically tested and scanned by means of a CT 1010 EMI scanner. Fifty age-matched controls, lifelong abstainers or light drinkers, were used for comparison. Fifty-six alcoholics from the initial sample were followed up after periods varying from 30 to 152 weeks, and radiological changes during the follow-up were assessed. The main results of the study can be summarized as follows: (1) All CT scan indices were significantly different in alcoholics and controls. Alcoholics had larger ventricles, wider cerebral sulci and wider Sylvian and interhemispheric fissures. Cerebellar sulci were visible only in alcoholics. These differences were greater for older alcoholics and controls, but were also present in the younger subjects. (2) In the alcoholic group the size of the ventricular system, and the width of the sulci, Sylvian and interhemispheric fissures were positively and significantly correlated with age. The duration of the drinking history and the age of onset were not significantly correlated with CT scan indices. (3) In those alcoholics whose age was greater than the mean for the whole group, the size of the ventricular system and width of the Sylvian fissure were significantly and negatively correlated with the duration of abstinence prior to scanning. (4) Other features such as decreased tolerance, a positive family history of alcoholism and 'social decline' were not significantly related to the severity of CT scan abnormalities. (5) When the effects of age and premorbid intelligence were controlled, alcoholics showed significant cognitive impairment when compared with controls. The differences in the scores of psychological tests and CT scan indices were greater between alcoholics and controls of high IQ than between those of low IQ. This discrepancy is likely to be due to a selection bias. (6) No significant correlations were found between the degree of cognitive impairment and clinical features. The size of the ventricular system was positively and significantly correlated with the discrepancy between immediate and delayed recall of verbal material. There were no other significant correlations between cognitive impairment and CT scan indices. (7) Those subjects who had remained abstinent during the follow-up period, when considered as a group, showed a significant reduction in the size of the ventricular system. When cortical indices and V/B ratio were combined, patients whose scans had improved at follow-up differed from the rest with regard to the length of abstinence prior to re-scanning.

Sonographic measurement of lateral ventricular width in early ventricular dilation

Cerebral real-time ultrasound examinations from 35 high-risk premature newborn infants and 25 normal-term infants were reviewed for early signs of ventricular dilation. Measurements of the midbody lateral wall of the lateral ventricle to falx distance and ratio of this distance to the hemispheric width were obtained. Midbody lateral ventricular widths were also measured. Results indicate that displacement of the medial wall of the body of the lateral ventricle toward the midline is an earlier sign of ventricular dilation than is displacement of the lateral wall away from the midline.

Stereotaxic brain operations in erethitic imbecility (author's transl)

Long-term results of stereotaxic operations in 23 patients with severe erethitic (aggressive-destructive) imbecility were evaluated. Target areas in the thalamus, electrocoagulated in separate bilateral operations, were the dorsomedial nucleus and the internal medullary lamina. Definite tranquilization was achieved in 50% and acquiescence in 27% of patients, resulting in a positive effect on more than 75% of patients. The postoperative course showed a constant level of quiet behavior in only 25% of patients ("static course"), whereas 50% of patients showed an oscillating course leading to subsequent improvement and later stabilization ("undulant course"). The final outcome was improvement and later stabilization ("undulant course"). The final outcome was not improved in 25% of patients. Additional therapeutic measures involving adaptation of psychopharmacotherapy improvements in surroundings, and play and working therapy were occasionally effective (Fig 3). In the pneumoencephalograms of these patients a new distinctive variant was encountered that awaits confirmation: typically, a definite increase in thalamic height, a decrease in ventricular width, and a relative diminution of base line length was found. Stereotaxic thalamotomy in erethitic imbeciles is a therapeutic method with a 75% long-term effectiveness and should be considered a proven therapeutic alternative.

Ultrasound studies in preterm infants with hydrocephalus

Serial ultrasound studies of cerebral ventricular size were obtained in 40 small preterm infants, 26 of whom were believed to be at risk for intracranial hemorrhage or hydrocephalus secondary to ICH or both. Hydrocephalus was diagnosed by ultrasound study in 12 of the high-risk infants, eight of whom required a surgical shunt procedure because of progressive ventricular enlargement. Serial ultrasound studies in the other 28 infants, including the 14 believed to be at low risk for ICH, disclosed normal ventricular size, defined as a ratio of lateral ventricular width to intracranial hemidiameter of less than 35%. The ultrasound methods utilized a portable A-mode echoscope that permitted unidimensional intracranial measurements at the infants' bedside, and a nonportable automated B-scanner that produced two-dimensional gray-scale images of the brain. The serial ultrasound measurements and images proved clinically useful in the initial detection of hydrocephalus and subsequent evaluation of the infant subjects.

Evaluation of fetal intracranial anatomy by static and real-time ultrasound.

Improvements in ultrasound technology have now made possible detailed visualization of fetal intracranial anatomy. Structures such as the midbrain, thalami, and lateral ventricles can be routinely imaged. Measurements of the ratio between lateral ventricular width and cerebral hemispheric width demonstrate a steady decrease from a mean of 56% at 15 wk gestation to 28% at term reflecting the relatively more rapid growth of the cerebral hemispheres as compared with the cerebral ventricles. Application of this new ultrasound data greatly facilitates accurate and consistent biparietal diameter estimations and early diagnosis of fetal hydrocephalus and other fetal cranial anomalies. This article describes the axial fetal cranial anatomy as demonstrated sonically and includes a table for normal fetal ventricular size at various gestational ages, based on evaluation of 196 normal fetuses. Some of the more common fetal cranial anomalies amenable to ultrasound diagnosis in utero are discussed.

The role of echocardiography in the selection of mitral valve prosthesis

Assessment of the left ventricular outflow tract was made echographically in 70 patients who subsequently received a mitral prosthesis. Group A (44 patients) had normal left ventricular outflow tract width (> 20 mm.); 13 received the Starr-Edwards prosthesis and nine received the Braunwald-Cutter prosthesis. There were two patients with low cardiac output syndrome and no hospital deaths. Group B (26 patients) had a narrow left ventricular outflow tract (<20 mm.). Thirteen patients received the Starr-Edwards prosthesis. One patient had low cardiac output syndrome, and there were no hospital deaths. We conclude that the use of the ball-and-cage prosthesis in the mitral position in patients with a narrowed left ventricular outflow tract (<20 mm.) measured echographically is not associated with an increased surgical risk.

Decrease in Ventricular and Sulcal Size After Death

Fifty-one intact corpses were examined with the EMI head scanner from 1 1/2-52 hours after death; 15 of these had antemortem CT scans. Seven had sequential postmortem CT scans. CT scans and autopsy findings for lateral ventricular size and sulcal width were compared. The lateral ventricular size generally, and the sulcal width occasionally, became smaller after death, though the decrease was usually mild. This decrease was demonstrated not only on antemortem and postmortem sequential CT scans, but on postmortem sequential CT scans alone as well.

Third ventricular width and the thalamocapsular border.

65 patients were selected to assess variations in third ventricular width. The patients suffered from various extrapyramidal movement disorders, and all had undergone stereotactic VL thalamotomies. Third ventricular width was correlated with age, sex, diagnosis and intercommissural distance. Based upon the analysis of somatosensory response mappings, a medial displacement of the thalamocapsular border was demonstrated for patients with narrow third ventricles.

The effects of operation on the echocardiographic features of idiopathic hypertrophic subaortic stenosis.

Simultaneous cardiac catheterizations and echocardiograms were performed before and 6-12 months following ventriculoseptomyectomy in 10 patients with idiopathic hypertrophic subaortic stenosis (IHSS) to define the effects of operation on the echocardiographic features of IHSS. Preoperatively, the resting peak systolic gradient ranged from 40-125 mm Hg and averaged 81 mm Hg. Postoperatively no gradient was present in nine patients and one patient had a 15 mm Hg residual gradient. Echocardiographic obstruction index averaged 54 msec/mm (range 35-85) preoperatively and was reduced to 12 msec/mm (0-67) postoperatively. The markedly abnormal systolic anterior motion (SAM) of the anterior mitral leaflet present in all preoperatively was diminished or absent following operation. The preoperative left ventricular outflow tract dimension, calculated by echocardiogram at peak SAM, averaged 1.4 mm (range 0-5) and increased to 15 mm (3-25) following operation. Ventricular septal width averaged 18 mm (range 14-21) and posterior wall thickness averaged 11 mm (range 7-13) and were unchanged following operation. Mitral valve diastolic closing velocity, measured echocardiographically was not altered by operation (average 35 mm/sec before and after operation), suggesting that significant changes in left ventricular compliance did not occur. The echocardiogram in patients after ventriculoseptomyectomy demonstrates more normal mitral valve motion and increased left ventricular outflow tract dimension. In some patients uneven mitral leaflet-septal contact may produce significantly abnormal areas of SAM without obstruction.