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DILATED CISTERNA MAGNA A DIAGNOSTIC DILLEMA

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DILATED CISTERNA MAGNA A DIAGNOSTIC DILLEMA

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    1. DILATED CISTERNA MAGNA A DIAGNOSTIC DILLEMA DR. MUHAMMAD YAR MBBS, MCPS, FCPS FELLOW NEONATOLOGY

    2. MEGA CISTERNA MAGNA A mega-cisterna magna, in general is the term applied to non pathological prominance of the retro-cerebellar CSF space and not associated with cerebellar abnormalities (e.g. Dandy-Walker malformation etc..).

    3. The cisterna magna is located between the cerebellum and the dorsal surface of the medulla oblongata.CSF produced in the 4th ventricle drains into the cisterna magna via the lateral apertures and median aperture.The cisterna magna is located between the cerebellum and the dorsal surface of the medulla oblongata.CSF produced in the 4th ventricle drains into the cisterna magna via the lateral apertures and median aperture.

    4. DANDY WALKER COMPLEX Dilaetd cisterna magna Dandy –Walker malformation Cytic dilatation of 4th ventricle with parial or complete agenesis of the vermis. Dandy –Walker varient (partaial agenesis of cerebellar vermis)

    5. DIAGNOSTIC MODALITIES OF POST.FOSSA ANOMALIES Antenatal Fetal US Fetal MRI Post natal Head US Brain MRI

    6. This viewis used for measurement of TCD (tranverse cerebellar diameter) ans CMThis viewis used for measurement of TCD (tranverse cerebellar diameter) ans CM

    7. ANTENATAL SCAN Enlarged cisterna magna is diagnosed if the vertical distance from the vermis to the inner border of the skull is >10 mm. Dandy –Walker varient (partaial agenesis of cerebellar vermis) without enlargement of posterior fossa. In the Dandy –Walker malformation there is cytic dilatation of 4th ventricle with parial or complete agenesis of the vermis. Dandy –Walker varient (partaial agenesis of cerebellar vermis) without enlargement of posterior fossa. In the Dandy –Walker malformation there is cytic dilatation of 4th ventricle with parial or complete agenesis of the vermis.

    9. OBJECTIVES Prevalence of isolated dilated cisterna magna over 5 years by fetal sonography and by postnatal neuroimaging. The second objective was to assess the accuracy with which fetal ultrasound predicts postnatal neuroimaging findings in this population. The first objective of our study was to describe the The first objective of our study was to describe the

    10. MATERIALS AND METHODS We retrospectively identified all cases of suspected fetal isolated dilated cisterna magna from 2007 through 2011 till July. We reviewed maternal, fetal, neonatal, and follow-up records of all cases and fetal and early postnatal imaging studies.

    12. RESULTS Outcomes for isolated dilated cisterna magna identified over 5-year study period. Total deliveries 25443 Unbooked 4100 Antenatal scans Dilated cisterna magna 26 Postnatal scans 20 (18+2) Normal 12 (11+1) Abnormal 8 (7+1) False positive 40% No post natal scans 4 Delivered outside 2

    18. The prenatal diagnosis of posterior fossa dysgenesis remains challenging due to both false-positive and false-negative diagnoses. Limperopoulos C et al. Am J Obstet Gynecol 2006; 194:1070 -1076 Despite the rapid progress in fetal imaging, Despite the rapid progress in fetal imaging,

    20. Clinical significance of isolated mega cisterna magna Adults with isolated mega cisterna have an overall normal cognitive functioning but may score inferior to controls on some paramet of memory and verbal fluency. Archives of Gynecology and Obstetrics (2007) Volume: 276

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