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2015-08-10-22 Answer to the case of the week #402 © Karapetyan 

Answer to the case of the week #402

August 27, 2015 - September 10, 2015

Lusine Karapetyan, MD.


Case report

28-year-old woman (G1P0) with unremarcable medical history presented to our office at 12 weeks and 3 days of pregnancy. Our ultrasonographic examination revealed following cranial findings:

- enlarged thickness of the brainstem (BS) in sagittal planes;
- decreased size of the intracranial lucency (fourth ventricle) and cisterna magna (brainstem-occipital bone distance - BSOB distance).

The findings were suspected of spinal defect [1, 2, 3]. Repeated scan at 15 weeks and 3 days had confirmed opened lumbosacral spina bifida with classical cranial findings and pregnancy has been terminated.

Images 1, 2, 3, 4, and videos 1, 2, 3: 12 weeks and 3 days of gestation.




Images 5, 6: The image 5 shows abnormal findings that were seen in our case - increased size of the brainstem, decreased size of intracranial lucency together with compression of cisterna magna (decreased brainstem-occipital bone distance). For comparison normal findings are shown in the image 6 (for more information read articles stated in references).

Images 7, 8, 9, 10, 11, and videos 4, 5: 15+3 weeks - 2D and 3D images and videos showing classical signs of lumbosacral spina bifida.





1. Karl K, Heling KS, Chaoui R. Fluid area measurements in the posterior fossa at 11-13 weeks in normal fetuses and fetuses with open spina bifida. Fetal Diagn Ther. 2015;37(4):289-93. doi: 10.1159/000365989. Epub 2015 Feb 10. PubMed PMID: 25677252.

2. Lachmann R, Chaoui R, Moratalla J, Picciarelli G, Nicolaides KH. Posterior brain in fetuses with open spina bifida at 11 to 13 weeks. Prenat Diagn. 2011 Jan;31(1):103-6. doi: 10.1002/pd.2632. PubMed PMID: 21188735.

3. Mangione R, Dhombres F, Lelong N, Amat S, Atoub F, Friszer S, Khoshnood B, Jouannic JM. Screening for fetal spina bifida at the 11-13-week scan using three anatomical features of the posterior brain. Ultrasound Obstet Gynecol. 2013 Oct;42(4):416-20. doi: 10.1002/uog.12463. PubMed PMID: 23494913.

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