Asymmetrical Ventricles in Newborn Brain Ultrasound

Abnormal findings in neonatal cranial ultrasound examination?

Hello, my baby was born on April 19, 2007.
We had a self-paid neonatal brain ultrasound examination, and when we reviewed the report on May 19, the doctor informed us of an abnormality—there is asymmetry in the size of the lateral ventricles.
A follow-up examination was arranged for June 5, and the results still showed the same abnormality—asymmetry in the size of the lateral ventricles.
Therefore, we have scheduled another follow-up for July 31.

I would like to ask:
1.
What could be the possible causes of this abnormality?
2.
What impacts or symptoms might arise from this condition?
3.
Will this affect the IQ?
4.
Should I take my baby to another hospital for further examination?
5.
Are there any pediatricians in Taoyuan who have performed neonatal brain ultrasound examinations for babies? (I saw Dr.
Chang Chao-Liang in the physician roster, but I couldn't find his clinic schedule.) Thank you for your assistance.

Qì'é māmā, 20~29 year old female. Ask Date: 2007/06/06

Dr. Pei Rensheng reply Pediatrics

Hello,
(1) Asymmetry in the size of the lateral ventricles may indicate a non-technical issue (not being cut in the same plane).
If the size difference is not significant, it could be due to unknown reasons, which is often benign.
However, if the difference is pronounced or increases over time, there may be concern for hydrocephalus.

(2) Causes and types of hydrocephalus: Functional hydrocephalus is classified into obstructive and communicating types.

1.
Causes are as follows:
- Obstructive hydrocephalus
- Communicating hydrocephalus
- Narrowing of the aqueduct
- Arnold-Chiari malformation (congenital)
- Post-infectious (after meningitis, toxoplasmosis, cytomegalovirus infection)
- Secondary to subarachnoid hemorrhage
- Tumors in the midline of the brain
- Secondary to overproduction of cerebrospinal fluid (choroid plexus papilloma)
- Galenic venous malformation
- Connective tissue diseases
- Subdural hematoma in the posterior fossa
- Vitamin A toxicity
- Dandy-Walker malformation
(3) Clinical examinations include:
1.
Head circumference measurement
2.
Brain ultrasound
3.
Brain CT or MRI scans
(4) Diagnosis: Clinically, hydrocephalus is classified into:
1.
Acute hydrocephalus: Sudden obstruction of the ventricular system due to intracranial lesions, leading to rapid ventricular enlargement.
2.
Chronic hydrocephalus: Incomplete obstruction of the cerebrospinal fluid pathways, resulting in slow ventricular enlargement and gradual disease progression.
(5) Symptoms:
1.
Infant onset:
- Abnormal enlargement of the head, especially the forehead.
- Rapid progression of hydrocephalus may cause bulging of the anterior fontanelle, with palpable separation of the cranial sutures.
- Prominent scalp veins.
- Thinning and smoothness of the scalp.
- Increased intracranial pressure, with a higher-pitched cry.
- In severe cases, the eyes may deviate upward (sunset sign).

2.
Late childhood onset:
- No significant increase in head size.
- Increased intracranial pressure, with papilledema, leg stiffness, ataxia, and urinary incontinence.
- Progressive decline in intelligence.
- Excessive talking.
(2) Dr.
Chang Chao-Liang will be on vacation in May and will resume outpatient services in June, specifically on Monday afternoons of even-numbered weeks (6/11 and 6/25).
Please register on-site for special outpatient services.

Wishing you health and happiness!
Sincerely,
Dr.
Pei Ren-Sheng, Chief of Pediatrics
960608

Reply Date: 2007/06/06

More Info

Understanding asymmetrical ventricles in a newborn's brain ultrasound can be a source of concern for new parents, especially when the results indicate abnormalities. In your case, the ultrasound findings show that the left and right ventricles of your baby's brain are not of equal size, which is referred to as ventricular asymmetry. Let's break down your questions and concerns regarding this condition.

1. Possible Causes of Ventricular Asymmetry: There are several potential causes for asymmetrical ventricles in newborns. These can include developmental variations that are benign and may resolve on their own, or they could indicate underlying conditions such as ventriculomegaly (enlargement of the ventricles), hydrocephalus (accumulation of cerebrospinal fluid), or even structural brain anomalies. In some cases, asymmetry can be a result of brain injury, such as intraventricular hemorrhage, which is more common in premature infants. It’s essential to discuss these possibilities with your pediatrician or a pediatric neurologist, who can provide a more tailored assessment based on your baby's specific situation.

2. Potential Effects and Symptoms: The impact of ventricular asymmetry can vary widely. Some infants may show no symptoms and develop normally, while others may experience developmental delays or neurological issues. Symptoms to watch for include changes in muscle tone, developmental milestones not being met, or unusual behaviors. Regular follow-ups with your healthcare provider are crucial to monitor your baby's development and address any emerging concerns.

3. Impact on Intelligence: The relationship between ventricular asymmetry and cognitive function is complex. While some studies suggest that significant ventricular enlargement can be associated with developmental delays or cognitive impairments, many children with mild asymmetry develop normally. Continuous monitoring and early intervention, if necessary, can significantly improve outcomes. It’s important to focus on your child’s overall development rather than solely on the ultrasound findings.

4. Seeking Further Evaluation: If you have ongoing concerns about your baby's condition, it may be beneficial to seek a second opinion or further evaluation at a different hospital or clinic. A pediatric neurologist can provide specialized insights and may recommend additional imaging or assessments to better understand the situation. It’s essential to feel confident in the care your child is receiving.

5. Finding a Pediatric Specialist: In your area, it’s advisable to consult with a pediatric neurologist or a pediatrician who specializes in developmental issues. If you are considering Dr. Zhang Zhao-Liang, it might be worth contacting the clinic directly to inquire about his availability and whether he can assist with your baby's ultrasound follow-up. Additionally, your current pediatrician can provide referrals to specialists who are experienced in managing cases of ventricular asymmetry.

In conclusion, while the diagnosis of asymmetrical ventricles can be alarming, many infants with this condition go on to develop normally. Regular follow-ups, monitoring developmental milestones, and maintaining open communication with your healthcare providers are key steps in ensuring your baby's health and well-being. Early intervention, if needed, can make a significant difference in outcomes, so staying proactive is essential.

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