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Paediatric

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Neurology

Question
91 out of 92
 

Infant wid congestive cardiac failure.. bulging fontanelle with a bruit which can be auscultated.. CT shows midline lesion with dilated lateral ventricles diagnosis is..? (AIIMS, May 2010)



A Vein of Galen malformation

B Arachnoid cyst

C Teratoma

D None of the above

Ans. A

Vein of Galen malformation (VGAM) Ref: Nelson textbook of Pediatrics 18t Page, 1988, 2511

1. VGAM

1. It usually causes high-output heart failure in the newborn resulting from the decreased resistance and high blood flow in the lesion.

2. Associated findings include cerebral ischemic changes such as strokes or steal phenomena that result in progressive hemiparesis.

3. Hemorrhage from the malformation can occur, although this is not a common finding. Finally, the malformation may result in mass effects, causing progressive neurological impairment.

4. Alternatively, the malformation may cause obstruction of the cerebrospinal fluid (CSF) outflow and result in hydrocephalus teratoma or arachnoid cyst not causes bruit on auscultation.

2. Arachnoid cysts

1. They are cerebrospinal fluid covered by arachnoidal cells and collagen that may develop between the surface of the brain and the cranial base or on the arachnoid membrane, one of the three membranes that cover the brain and the spinal cord.

2. Arachnoid cysts are a congenital disorder, and most cases begin during infancy; however, onset may be delayed until adolescence

3. Teratoma

1. A teratoma is an encapsulated tumor with tissue or organ components resembling normal derivatives of all three germ layers. There are rare occasions when not all three germ layers are identifiable.

2. The tissues of a teratoma, although normal in themselves, may be quite different from surrounding tissues, and may be highly disparate; teratomas have been reported to contain hair, teeth, bone and very rarely more complex organs such as eye, torso, and hands, feet, or other limbs.

3. Usually, however, a teratoma will contain no organs but rather one or more tissues normally found in organs such as the brain, thyroid, liver, and lung.

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