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Preterm baby has cyst in the periventricular area of the brain. How to cure this?

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Pediatrician, Critical Care
Practicing since : 2001
Answered : 208 Questions
Hi Doctor,

My wife delivered a pre term baby girl at 32 weeks 3 days. Baby's wiedt at birth was 1.8 kgs, and she was admitted to the NICU immediately after birth.

She has now spent 10 days in the NICU, while her wieght is now increasing steadily and her blood test results have come good, the paedriatician at the NICU has mentioned about a flare in the USG of the skull performed.

The USG was performed twice within 7 - 8 days, and as per the doctor there is a cyst in the perventricular area of the baby's brain.
The doctor explained that this is observed in some preterm babies and there are chances that the cyst (flare) would heal on its own. He also mentioned that they would do a weekly USG scan to check status on the cyst.
He also told me the implications can be delays, impacted motor / educational skills, etc.

I need your assistance with the below queries
1. Is this usual in per term babies to have a cyst (in the PV area)
2. Are there chances that the cyst would recover itself. If yes than how many weeks ?
3. Any questions that I need to ask the doctor at NICU

Is there anything that I need to be concerned about now? the doctor at NICU told me that they would observe the status and condition of the baby.

Posted Sun, 28 Apr 2013 in Child Health
Answered by Dr. Tejas Shah 18 hours later
Thanks XXXXXX for asking my opinion in this matter. I will be glad to answer your queries.

It is good to know that your daughter is doing well. Usually, babies born at this gestation have breathing difficulties, some of them need support of ventilator in first few days of life as well. From your description, it seems she did not have any breathing or blood pressure issues.

Flaring on USG Brain is usually a bright signal outside the ventricles (fluid-filled structure) in the brain. As an isolated finding, it doesn't have too much prognostic value (doesn't help to give future neurological progress). Flaring does disappear on follow-up scan by 35-37 weeks gestation age (4-5 weeks time in your case)

Outcome related to cyst in the periventricular area of the brain is related to size and extent, whether there is associated hemorrhage in the brain and whether it is present on both sides or not.

Isolated very small cystic lesion in brain in periventricular area is unlikely to affect significant parts of the brain and hence very slim chances of having bad neurological outcome later in life.

Flare or cysts in periventricular area usually is related to changes in blood flow in that particular part of the brain. If there is any compromise in the blood supply for whatever the reason, that part of the brain gets slightly less blood supply as compared to surrounding areas of the brain and hence, they are seen as flare. (This compromise can be antenatal i.e. even before the delivery of the baby, if there are medical problems in mother).

Apart from this, cysts can be normal variant (many babies have it, without any reason and there is no future problem associated with it being present).

Ideal practice in this situation would be:

1. To get weekly USG Scan (Most neonatal units do USG in preterm babies and many subtle abnormalities like flare, cyst etc gets picked up like in your scenario)

2. If there is any increase in the size of the cyst, then a MRI or CT Scan Brain to further identity the lesion

Brain of babies have remarkable plasticity and isolated small lesions usually don't have much neurological issues later in the life.

In summary:
1. Cysts in Periventricular area are seen regularly in preterm babies, however not that common as compared to periventricular flare
2. Cysts do decrease in size, and hence the need to have regular weekly USG Brain and definitive imaging in form of MRI or CT Brain before discharge
3. Please ask about size, whether it is present on both sides or not, are the size of ventricles normal?

Please do revert back if you have any further queries after discussion with your doctor.

Dr Tejas Shah

Above answer was peer-reviewed by
Follow-up: Preterm baby has cyst in the periventricular area of the brain. How to cure this? 7 hours later

Thank you for your assistance, your reply did reduce my anxiety to a great extent.

You are right, my baby had slight initial breathing difficulty, and was given oxygen support for about a day, however no ventillator support was required.

I now have the outcome of the head sonography test performed on my daugher at 9 days, and it reads as,

"No ventricular dilation seen.

Small cysts seen of the size of 2.2 to 3.6 mm in diameter in left caudothalamic groove area and right subependymal region.

No GM haemorrage or intraventricular bleed observed.

Periventricular flare is present.

Midline structures are normally outlined.

Conclusion - bilateral subependymal cysts plus periventricular flare."

I did research about 'subependymal cysts' and 'PV flare' online.
I understand that there are about 50% chances of the cysts disappearing in a few weeks.
I also gather from your reply that the PV flare also may disappear at the gestational age of 35 - 37 weeks.

The doctor at the NICU hasn't explained the above report in detail; he mentioned about having follow-up scans done and keeping the baby in observation.

He too has mentioned about weekly USG scan.
I would check with the doctor on MRI / CT prior to discharge.

From the above diagnosis, is there any thing else that I should be concerned about? Is there any other information that you would require?, in case you do, I can check with the doctor.

I would keep you posted on the weekly follow-up tests and seek your guidane.

Thanks once again.
Answered by Dr. Tejas Shah 9 hours later
Thanks for getting back to me. Information you've mentioned is sufficient for me to get an idea about the extent of the problem.

Subependymal cysts of this small size is usually not to be worried about.

Based on the report, I would suggest just follow-up with USG Scan and CT/MRI for detailed evaluation before discharge. In most cases, these abnormalities have either disappeared or don't lead to any abnormality in development.

Please revert back if you have further queries or after the follow-up ultrasound is done. Don't worry at this stage. Also let your wife know as well, because if she becomes too concerned, it can affect her milk production etc (I don't know if the baby is being given breast milk)

Dr Tejas
Above answer was peer-reviewed by
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