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What Causes Increased Atrial Diameter Of Lateral Ventricle In Fetus?
Question: Hi, am having twins through a surrogate. At week 20, the ventricles of one of the twins measured 10mm. However, since then, the size has progressively increased around an mm every two weeks to the point where currently at week 30, these are measuring 14 and 15mm. It is isolated - the karyotype, foetal MRI and all other ultrasound indications are normal. I want to understand the implications of this ventriculomegaly - what factors improve or adversely affect the prognosis? Am very concerned.
Brief Answer:
If it remains stable at below 15 mm,it is of no clinical significance.
Detailed Answer:
Hi XXXXXXXX,
Thanks for being on Healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
Though in one of your twins,the atrial diameter of the lateral ventricle has been increasing,but it's of no clinical significance if it stabilises below 15mm.
Also,since karyotyping,ultrasound and Fetal MRI are normal,it can be well said that no serious associations are present.It's good that Fetal MRI turned out to be normal and associated severe conditions like agenesis of corpus callosum, Dandy-walker malformation and chiari malformations are ruled out.
Now,I hope that this is only a benign ventriculomegaly and the size will probably stabilise at this point.
Till this point,there is no scope for improving the prognosis as no harm has occurred as yet.
Fetal MRI,karyotyping and ultrasound are normal, ruling out other associations(as I mentioned above),which if otherwise present could have caused worse prognosis.
If the size of the lateral ventricle keeps increasing beyond 15 mm,this can cause development delay,mental and motor retardation.It can also lead to hydrocephalus then.This is how it can adversely affect the prognosis.
Hope I answered your query.If you have some follow-up questions,I shall be glad to answer else,please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
If it remains stable at below 15 mm,it is of no clinical significance.
Detailed Answer:
Hi XXXXXXXX,
Thanks for being on Healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
Though in one of your twins,the atrial diameter of the lateral ventricle has been increasing,but it's of no clinical significance if it stabilises below 15mm.
Also,since karyotyping,ultrasound and Fetal MRI are normal,it can be well said that no serious associations are present.It's good that Fetal MRI turned out to be normal and associated severe conditions like agenesis of corpus callosum, Dandy-walker malformation and chiari malformations are ruled out.
Now,I hope that this is only a benign ventriculomegaly and the size will probably stabilise at this point.
Till this point,there is no scope for improving the prognosis as no harm has occurred as yet.
Fetal MRI,karyotyping and ultrasound are normal, ruling out other associations(as I mentioned above),which if otherwise present could have caused worse prognosis.
If the size of the lateral ventricle keeps increasing beyond 15 mm,this can cause development delay,mental and motor retardation.It can also lead to hydrocephalus then.This is how it can adversely affect the prognosis.
Hope I answered your query.If you have some follow-up questions,I shall be glad to answer else,please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Prasad
Thanks for your response, Dr. Pawar! Two quick follow up questions -
(1) Does the ventricle increase beyond 15mm always result in developmental delay or mental and motor retardation? What are the odds?
(2) Our doctor had suggested that if the ventricle keeps increasing, we could put a shunt as soon as the baby is born. Will this improve the neurological outcome?
(1) Does the ventricle increase beyond 15mm always result in developmental delay or mental and motor retardation? What are the odds?
(2) Our doctor had suggested that if the ventricle keeps increasing, we could put a shunt as soon as the baby is born. Will this improve the neurological outcome?
Brief Answer:
Not always but risk increases.Shunting definitely improves outcome.
Detailed Answer:
Hi XXXXXXX,
Thanks for being in follow-up.
You are welcome for the day.
Answers to your queries-
1)If the ventricle size increases beyond 15 mm,there is an increased risk of developing hydrocephalus which can compress the brain parenchyma,thus retarding mental and motor development.But as I say,there is an increased risk but not always,and the odds in your case are that there are no associated anomalies,which I earlier mentioned.Actually it depends on the progressive enlargement of ventricle,like if ventricle stops at 15.1 or 15.2,it may not cause harm.However,if it keeps increasing then it may result into hydrocephalus.
2)Baby after birth is observed for 4 to 6 weeks for progressive enlargement of ventricles.If ventricles are not enlarging and cerebrospinal fluid(csf) is draining well(no hydrocephalus),there may be no need of shunt.But,if there is progressive enlargement of ventricle with impaired csf draining,ventriculoperitoneal(VP) shunting should be done to prevent the compressive effects on brain parenchyma. It definitely improves the neurological outcome in terms of baby's mental and motor development.
Hope I answered your query.If you have some follow-up questions,I shall be glad to answer else,please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
Not always but risk increases.Shunting definitely improves outcome.
Detailed Answer:
Hi XXXXXXX,
Thanks for being in follow-up.
You are welcome for the day.
Answers to your queries-
1)If the ventricle size increases beyond 15 mm,there is an increased risk of developing hydrocephalus which can compress the brain parenchyma,thus retarding mental and motor development.But as I say,there is an increased risk but not always,and the odds in your case are that there are no associated anomalies,which I earlier mentioned.Actually it depends on the progressive enlargement of ventricle,like if ventricle stops at 15.1 or 15.2,it may not cause harm.However,if it keeps increasing then it may result into hydrocephalus.
2)Baby after birth is observed for 4 to 6 weeks for progressive enlargement of ventricles.If ventricles are not enlarging and cerebrospinal fluid(csf) is draining well(no hydrocephalus),there may be no need of shunt.But,if there is progressive enlargement of ventricle with impaired csf draining,ventriculoperitoneal(VP) shunting should be done to prevent the compressive effects on brain parenchyma. It definitely improves the neurological outcome in terms of baby's mental and motor development.
Hope I answered your query.If you have some follow-up questions,I shall be glad to answer else,please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Shanthi.E
Final questions, Dr. Panwar.
(a) I read on the Internet about X-linked recessive hydrocephalus (Bickers-Adam syndrome): is there any way to know whether this is the case with our twin?
(b) Also, does this form of X-linked hydrocephalus present with aqueductal stenosis alone or other malformations? Would stenosis or other malformations have been diagnosed in the MRI that we already conducted or is it possible to detect this only after birth?
Thanks much for your inputs!!!
(a) I read on the Internet about X-linked recessive hydrocephalus (Bickers-Adam syndrome): is there any way to know whether this is the case with our twin?
(b) Also, does this form of X-linked hydrocephalus present with aqueductal stenosis alone or other malformations? Would stenosis or other malformations have been diagnosed in the MRI that we already conducted or is it possible to detect this only after birth?
Thanks much for your inputs!!!
Brief Answer:
Ventriculomegaly without aqueductal stenosis is not Bickers-Adams syndrome.
Detailed Answer:
Hi,
Thanks for being in follow-up.
You are welcome for the day.
The hallmark feature of 'Bickers-Adams syndrome' or 'X-linked hydrocephalus' is stenosis of 'Aqueduct of sylvius'. When this aqueduct gets stenosed, then there is obstruction to the flow of CSF from 3rd ventricle to 4th ventricle. CSF then accumulates in 3rd ventricle and lateral ventricles leading to obstructive hydrocephalus.
'Ventriculomegaly' without aqueductal stenosis as apparently in your fetus, is not 'Bickers-adams syndrome'. Fetal MRI didn't show aqueductal stenosis, so this syndrome is ruled out. Please upload fetal MRI image if possible.
'Aqueductal stenosis' is the key feature of this syndrome. Other associations may be present sometimes but without aqueductal stenosis, it's ruled out.
By this time, fetal MRI would have shown malformations and other associations. This syndrome is ruled out.
Hope I answered your query. If you have some follow-up questions, I shall be glad to answer else, please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
Ventriculomegaly without aqueductal stenosis is not Bickers-Adams syndrome.
Detailed Answer:
Hi,
Thanks for being in follow-up.
You are welcome for the day.
The hallmark feature of 'Bickers-Adams syndrome' or 'X-linked hydrocephalus' is stenosis of 'Aqueduct of sylvius'. When this aqueduct gets stenosed, then there is obstruction to the flow of CSF from 3rd ventricle to 4th ventricle. CSF then accumulates in 3rd ventricle and lateral ventricles leading to obstructive hydrocephalus.
'Ventriculomegaly' without aqueductal stenosis as apparently in your fetus, is not 'Bickers-adams syndrome'. Fetal MRI didn't show aqueductal stenosis, so this syndrome is ruled out. Please upload fetal MRI image if possible.
'Aqueductal stenosis' is the key feature of this syndrome. Other associations may be present sometimes but without aqueductal stenosis, it's ruled out.
By this time, fetal MRI would have shown malformations and other associations. This syndrome is ruled out.
Hope I answered your query. If you have some follow-up questions, I shall be glad to answer else, please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thank you for the response.
I don't have the MRI image but have uploaded the report. Please do take a look. This MRI was conducted on Nov 29 and the ventricles were 12.1 and 12.5mm at that time. The latest ultrasound on XXXXXXX 7 shows them at 14 and 15mm. We have been very anxious since the pediatrician said "15 is not good".
When do the ventricles typically stabilize in the foetus? Our doc had expected the ventricles to stabilize by now but it seems they are still growing. Thanks!
I don't have the MRI image but have uploaded the report. Please do take a look. This MRI was conducted on Nov 29 and the ventricles were 12.1 and 12.5mm at that time. The latest ultrasound on XXXXXXX 7 shows them at 14 and 15mm. We have been very anxious since the pediatrician said "15 is not good".
When do the ventricles typically stabilize in the foetus? Our doc had expected the ventricles to stabilize by now but it seems they are still growing. Thanks!
Brief Answer:
MRI does not show any malformations or aqueductal stenosis.
Detailed Answer:
Hi XXXXXX,
Thanks for being in follow-up.
I have gone through the fetal MRI report.No malformations or aqueductal atenosis.It is 'Isolated ventriculomegaly'.
Ventricles typically stabilise after 22-24 weeks.They can keep growing in some without causing harm,then called 'Benign ventriculomegaly'.Let us hope that ventricles size don't grow much beyond.
Hope I answered your query. If you have some follow-up questions, I shall be glad to answer else, please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
MRI does not show any malformations or aqueductal stenosis.
Detailed Answer:
Hi XXXXXX,
Thanks for being in follow-up.
I have gone through the fetal MRI report.No malformations or aqueductal atenosis.It is 'Isolated ventriculomegaly'.
Ventricles typically stabilise after 22-24 weeks.They can keep growing in some without causing harm,then called 'Benign ventriculomegaly'.Let us hope that ventricles size don't grow much beyond.
Hope I answered your query. If you have some follow-up questions, I shall be glad to answer else, please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Raju A.T
Hi Dr. Panwar,
We visited a local neurosurgeon in Hyd, who gave us a provisional diagnosis of "lateral ventriculomagely with stenosis of foramen of Monro ( Intrauterine)". My husband visited him and so, I could not get too much info. But wanted your opinion on the following questions:
(a) Is it possible for him to suspect this given the MRI report that I uploaded and the observation of VM alone?
(b) What is the prognosis of this? I could not find any info online. He said if confirmed after MRI of child, he would do an endoscopic surgery.
(c) Is there no probability of the child being normal given a diagnosis of isolated severe ventriculomegaly?
Thanks!
We visited a local neurosurgeon in Hyd, who gave us a provisional diagnosis of "lateral ventriculomagely with stenosis of foramen of Monro ( Intrauterine)". My husband visited him and so, I could not get too much info. But wanted your opinion on the following questions:
(a) Is it possible for him to suspect this given the MRI report that I uploaded and the observation of VM alone?
(b) What is the prognosis of this? I could not find any info online. He said if confirmed after MRI of child, he would do an endoscopic surgery.
(c) Is there no probability of the child being normal given a diagnosis of isolated severe ventriculomegaly?
Thanks!
Brief Answer:
Please upload Fetal MRI images/discuss the MRI film with a radiologist.
Detailed Answer:
Hi XXXXXXX,
Thanks for being in follow-up.
Though the Fetal MRI report you uploaded did not mention 'stenosis of foramen of monro'.Still,sometimes radiologist's report may not be 100% correct due to the lack of clinical correlation.If you could have uploaded MRI images,I would have looked at it for what the neurosurgeon made a comment.Alternatively,you can discuss the MRI film with a good radiologist/neuroradiologist at your place,if he agrees with the stenosis of foramen of monro as commented by the neurosurgeon.
Even if detected,prognosis is very good with endoscopic surgery and ventriculoperitoneal shunt(VP shunt).
As I already mentioned that with isolated ventriculomegaly,prognosis will be good (child may be normal) if the ventriculomegaly is not severe enough to develop hydrocephalus.Even with hydrocephalus,VP shunt carries a good prognosis.
Hope I have answered your query.If you have any further queries,I shall be glad to answer,else please close the thread and rate it.
Dr.Ajay Panwar,
MD,DM(Neurology)
Please upload Fetal MRI images/discuss the MRI film with a radiologist.
Detailed Answer:
Hi XXXXXXX,
Thanks for being in follow-up.
Though the Fetal MRI report you uploaded did not mention 'stenosis of foramen of monro'.Still,sometimes radiologist's report may not be 100% correct due to the lack of clinical correlation.If you could have uploaded MRI images,I would have looked at it for what the neurosurgeon made a comment.Alternatively,you can discuss the MRI film with a good radiologist/neuroradiologist at your place,if he agrees with the stenosis of foramen of monro as commented by the neurosurgeon.
Even if detected,prognosis is very good with endoscopic surgery and ventriculoperitoneal shunt(VP shunt).
As I already mentioned that with isolated ventriculomegaly,prognosis will be good (child may be normal) if the ventriculomegaly is not severe enough to develop hydrocephalus.Even with hydrocephalus,VP shunt carries a good prognosis.
Hope I have answered your query.If you have any further queries,I shall be glad to answer,else please close the thread and rate it.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Raju A.T
That's what I found intriguing. I don't have a copy of the MRI film and hence, did not upload it. All this doc had access to was the MRI report I uploaded and the sonologist's weekly ultrasound report that says the following:
"Twin 2 reveals isolated moderate ventriculomegaly.Left Lateral ventricle measures 1.5 cm. Right Lateral ventricle measures 1.4 cm The ventricular outlines are normal and contents are clear The cavum septum and cerebellum appear normal. Fetal spine appears normal. No other abnormality is seen. No obvious anatomical anomalies are seen in twin 1. Normal fetal cardiac activity and fetal biophysical profile is seen in both the fetuses."
He cannot really conclude stenosis from that, can he? And the radiologist who did the MRI is also very good. Would not the stenosis have shown up in the MRI? He has not mentioned any of this. Our pediatrician recommends MRI after the child is born. Thanks!
"Twin 2 reveals isolated moderate ventriculomegaly.Left Lateral ventricle measures 1.5 cm. Right Lateral ventricle measures 1.4 cm The ventricular outlines are normal and contents are clear The cavum septum and cerebellum appear normal. Fetal spine appears normal. No other abnormality is seen. No obvious anatomical anomalies are seen in twin 1. Normal fetal cardiac activity and fetal biophysical profile is seen in both the fetuses."
He cannot really conclude stenosis from that, can he? And the radiologist who did the MRI is also very good. Would not the stenosis have shown up in the MRI? He has not mentioned any of this. Our pediatrician recommends MRI after the child is born. Thanks!
Brief Answer:
No one on basis of that MRI report can comment stenosis.
Detailed Answer:
Hi XXXXXX,
Thanks for being in follow-up.
You are obviously correct in saying that 'no specialist on basis of that MRI report alone without film should comment that foramen of monro is stenosed.There is no apparent logic'.
I think he might have suggested foramen of monro stenosis as a cause to be looked for and if found, treated.He might have just thought it as a possibility.
I suggest you to please re-consult that radiologist.He will be able to tell whether 3rd ventricle is visible normally or slit like. (Although if it was like that, he should have mentioned it in report).If it is normally visible, there are no chances of obstruction (stenosis cause obstruction)at the opening between lateral ventricles and 3rd ventricle(foramen of monro).
Please follow-up if required.Thanks.
Dr.Ajay Panwar,
MD, DM (Neurology)
No one on basis of that MRI report can comment stenosis.
Detailed Answer:
Hi XXXXXX,
Thanks for being in follow-up.
You are obviously correct in saying that 'no specialist on basis of that MRI report alone without film should comment that foramen of monro is stenosed.There is no apparent logic'.
I think he might have suggested foramen of monro stenosis as a cause to be looked for and if found, treated.He might have just thought it as a possibility.
I suggest you to please re-consult that radiologist.He will be able to tell whether 3rd ventricle is visible normally or slit like. (Although if it was like that, he should have mentioned it in report).If it is normally visible, there are no chances of obstruction (stenosis cause obstruction)at the opening between lateral ventricles and 3rd ventricle(foramen of monro).
Please follow-up if required.Thanks.
Dr.Ajay Panwar,
MD, DM (Neurology)
Above answer was peer-reviewed by :
Dr. Raju A.T
Thanks, Dr. Panwar! That is what I had gathered from my research as well.
Quick follow up questions before I close the thread -
(a) Do you know of individuals with ventricles that are bigger than 15mm and have normal development?
(b) Also, will hydrocephalus be inferred purely through the lateral ventricle size? Third and fourth ventricles are "unremarkable" in our baby. Moreover, HC is measuring at 31.4 weeks for its gestational age of 30.1 weeks. If the VM develops into hydrocephalus, will we see an increase in the HC too?
Quick follow up questions before I close the thread -
(a) Do you know of individuals with ventricles that are bigger than 15mm and have normal development?
(b) Also, will hydrocephalus be inferred purely through the lateral ventricle size? Third and fourth ventricles are "unremarkable" in our baby. Moreover, HC is measuring at 31.4 weeks for its gestational age of 30.1 weeks. If the VM develops into hydrocephalus, will we see an increase in the HC too?
Brief Answer:
Hydrocephalus causes an increase in head circumference.
Detailed Answer:
Hi XXXXXXX,
Thanks for being in follow-up.
Answers to queries:
a)Actually prevalence of ventriculomegaly in newborns is very low.So,it is not usual that we see such cases.However, in my clinical practice,I have seen a couple of cases of borderline ventriculomegaly(1st one of around 14.9 mm and 2nd one of 15.2 mm) which had normal development.
b)Hydrocephalus can be communicating or non-communicating/obstructive-
Communicating hydrocephalus results in increase in size of lateral,third as well as fourth ventricles.
Non-communicating hydrocephalus results in enlargement of lateral ventricles.Third ventricle may be enlarged as well, if obstruction is below the level of third ventricle(aqueduct of sylvius),but if the obstruction is at the level of foramen of monro,third ventricle may remain slit like.Fourth ventricle is always slit like in obstructive hydrocephalus.
Third and fourth ventricle are unremarkable in your case means hydrocephalus has not developed as yet.
Head circumference usually increase in children/newborns with hydrocephalus.Please discuss with radiologist that this much difference between head circumference(31.4/30.1 weeks) with reference to gestational age is within physiological limits or not?He probably is in a better position to tell whether it is abnormal or not.
Hope I have answered your query.If you have further queries,I shall be glad to answer.
Dr.Ajay Panwar,
MD,DM(Neurology)
Hydrocephalus causes an increase in head circumference.
Detailed Answer:
Hi XXXXXXX,
Thanks for being in follow-up.
Answers to queries:
a)Actually prevalence of ventriculomegaly in newborns is very low.So,it is not usual that we see such cases.However, in my clinical practice,I have seen a couple of cases of borderline ventriculomegaly(1st one of around 14.9 mm and 2nd one of 15.2 mm) which had normal development.
b)Hydrocephalus can be communicating or non-communicating/obstructive-
Communicating hydrocephalus results in increase in size of lateral,third as well as fourth ventricles.
Non-communicating hydrocephalus results in enlargement of lateral ventricles.Third ventricle may be enlarged as well, if obstruction is below the level of third ventricle(aqueduct of sylvius),but if the obstruction is at the level of foramen of monro,third ventricle may remain slit like.Fourth ventricle is always slit like in obstructive hydrocephalus.
Third and fourth ventricle are unremarkable in your case means hydrocephalus has not developed as yet.
Head circumference usually increase in children/newborns with hydrocephalus.Please discuss with radiologist that this much difference between head circumference(31.4/30.1 weeks) with reference to gestational age is within physiological limits or not?He probably is in a better position to tell whether it is abnormal or not.
Hope I have answered your query.If you have further queries,I shall be glad to answer.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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