1. Neurosonography Part ONE Harry H
Neurosonography Part ONE Harry H. Holdorf PhD, MPA, RDMS (Ab, OB/Gyn, BR), RVT, LRT

2. Introduction 7-10 MHz transducer Scans are performed through
The anterior fontanelle;
Coronal planes
sagital planes
The coronal suture or the squamous portion of the temporal bone;
Axial plane , to identify extracerebral fluid
Doppler studies of the “Circle of Willis”
Posterior fontanelle;
Evaluation of the posterior fossa

3. Embriology, Color page 169
Centeral nervous system develop from ectoderm; it folds back and forms the “neural tube” which makes the CNS:
brain and spinal cord
Surrounding mesoderm forms:
Cranium, vertebral column, muscles
After 3 weeks development- three regions:
Fore brain (prosencephalon)
Midbrain (Mesencephalon)
Hindbrain (Rhombencephalon)

4. Embriology images

5. Embriology

6. Embriology images

7. Embriology

8. Forebrain( Prosencephalon)
Forms:
Telencephalon- forms
Cerebrum
Surrounds the Lateral ventricles
Diencephalon
Thalamus
Hypothalamus
Epithalamus
Surrounds the 3rd ventricle

9. Midbrain Forms Mesencephalon which develops into: Cerebral peduncles
Colliculi
The Aqueduct of Sylvius is located at this level.

10. Hindbrain (Rhombencephalon)
Forms:
Metencephalon (Upper)
Pons
Cerebellum
The Upper part of the 4thventricle is located at this level.
Myelencephalon (Lower)
Spinal cord
Medulla Oblongata
The Lower part of the 4th ventricle is located at this level.

11. Bones of cranium Color pages 24-25
One frontal bone- Form forehead
Two parietal bones- Form top
Two Temporal bones- Form sides
One Ethmoid bone - between eyes
One Sphenoid bone
Anterior to temporal bone
Wing-like shaped “sella tursica” holds pituitary center of Sphenoid bone
One occipital bone; large hole(Foramen Magnum) for passage of the spinal cord

12. Bones of cranium lateral view

13. Bones of cranium top view

14. Cranium bones interior view

15. Sutures, Page 24 of coloing book
Bones are connected by sutures, which are fibrous movable joints.
Allow for molding of the skull during birth.

16. Sutures cont. Sagital suture Coronal suture Lambdoidal suture
Between parietal bones- Form ant. And pos. fontanels
Closes from posterior to anterior
Fuses when frontal fontanels closes
Coronal suture
Between frontal and parietal bones
Perpendicular to sagital suture
Lambdoidal suture
Between parietal and occipital bones
Courses from mastoid portion of temporal bone to posterior portion of sagital suture
Squamosal suture
Between temporal and parietal bones

17. Skull of new born

18. Skull sutures and fontanels in neonates

19. Skull sutures top view

20. Skull sutures lateral view

21. Skull sutures lateral view

22. Skull sutures posterior view

23. Fontanels: Anterior Fontanel Posterior Fontanel Lateral Fontanels
Junction of sagital and coronal sutures called Bregma
Closes between 5-18 months
Posterior Fontanel
Junction of sagital and lambdoidal sutures called Lambda
Closes between 2-6 months
Lateral Fontanels
Sphenoidal/squamosal fontanels- Ant., 2-3 months.
Mastoid fontanels-post., 12 months

24. Fontanels

25. Fontanels

26. Cranial Meninges: Page 81
There are three layers of meninges:
Dura Mater- Outer layer
Arachnoid- Middle layer
Pia Mater- Innermost layer, highly vascular
The cerebral meninges are continious with the spinal meninges
The main function of meninges and CSF (cerebrospinal fluid) is to protect the brain and cord

27. Cranial Meninges:

28. Dura Mater
Folds inward and divide the cranial cavity. These folds include:
Falx cerebri- Between the cerebral hemispheres
Falx cerebelli- Between the cerebellar hemispheres
Tentorium cerebelli- Between cerebrum and cerebellum
Diaphragma sellae- Forms a bridge over the Sella Turcica

31. Cranial Meninges cont.
Dura Mater is separated from Arachnoid by the subdural space.
Arachnoid is separated from Pia Mater by the subarachnoid space.
Note- Subarachnoid space is where fluid is sampled for a spinal tap in the lumbar region.

32. Cranial Meninges cont.
The convolutions of the surface of the brain are called Sulci and Gyri.
The hills are gyri while the furrows are sulci.
The pia mater and arachnoidnare in close contact with gyri. Pia mater follows the dip of sulci while arachnoid bridges over the top of gyri and make subarachnoid spaces.

33. Grey and White matter organization of the brain and cord:
Found on The inner portion of the crebrum
Found on The outer portion of the spinal cord
Mostly axons
Grey matter:
Grey matter of cerebrum divides into:
Grey matter of the cerebral cortex
Grey matter of the basal ganglia
Grey matter of the cerebellar cortex
Grey matter of the inner portion of the spinal cord
Mostly cell bodies

34. Regions of the brain (CNS)
Cerebrum
Diencephalon
Cerebellum
Brain stem

35. CNS

36. Cerebrum Largest portion of the CNS Has two hemispheres.
There is a deep cleft between the cerebral hemispheres called Longitudinal Fissure or Interhemispheric Fissure.