Lemon and Banana signs

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Sameer Dikshit

My presentation on Lemon and Banana signs at AICOG 2012 at Varanasi

Health & Medicine Business

Dr.Sameer Dikshit MD, DGO,FCPS,FICOG Fetal Medicine Consultant, Mumbai

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Knowing earlier is always better than later !!!

Extrapolation of Arnold Chiari malformation in 1 st Trimester

1 st Trimester Equivalent of Banana sign

First Trimester equivalent of Lemon sign

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6 fetal skull dr ahmed esawy FETAL SKULL Microcephaly Teratogens Associated with Microcephaly Drugs (Alcohol, amniopterin, hydantoin) Maternal PKU Radiation exposure Infections ( Rubella, CMV, toxoplasmosis) congenital microcephalus and megalencephally lemon sign Lemon sign and Ventriculomegaly Binder syndrome Apert syndrome Trigonocephaly fetal craniosynostosis dolicocephaly-fetal Pfeiffer syndrome Saethre–Chotzen Syndrome Anencephaly Acrania Cephalocele Types: – 1. Meningoceles: only CSF – 2. Encephaloceles: Brain • Locations: – Occipital (75 %) – Frontoethmoidal (13 %) – Parietal (12 %) cephalic index

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This Journal Club presentation provides a summary and discussion of the following free access articles published in UOG: Prenatal diagnosis and outcome of fetal posterior fossa fluid collections G. Gandolfi Colleoni, E. Contro, A. Carletti, T. Ghi, G. Campobasso, G. Rembouskos, G. Volpe, G. Pilu, P. Volpe. Volume 39, Issue 6, Date: June 2012, pages 625–631 Brainstem–vermis and brainstem–tentorium angles allow accurate categorization of fetal upward rotation of cerebellar vermis P. Volpe, E. Contro, F. De Musso, T. Ghi, A. Farina, A. Tempesta, G. Volpe, N. Rizzo, G. Pilu Volume 39, Issue 6, Date: June 2012, 632–635 They can be accessed here: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1469-0705/homepage/journal_club_2012.htm

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Spina bifida is a birth disorder that involves the incomplete development of the spine. In the first month of pregnancy, a special set of cells forms the “neural tube;” the top of the tube becomes the brain, and the remainder becomes the spinal cord and structures around it. In spina bifida, the neural tube doesn’t close completely and some of the bones of the spine do not close in the back. This can result in an opening anywhere along the spine and may cause damage to the spinal cord and nerves.There are four types of spina bifida: occulta, closed neural tube defects, meningocele, and myelomeningocele. The symptoms of spina bifida vary from person to person, depending on the type and level of involvement. Most cases are mild and do not require special treatment. The more serious cases involve nerve damage. Occulta is the mildest and most common form in which one or more bones of the spinal column (vertebrae) are malformed. The name “occulta,” which means “hidden,” indicates that a layer of skin covers the opening in the bones of the spine. It usually shows no symptoms and is often found by accident on an x-ray or similar test. Closed neural tube defects are a diverse group of disorders in which the spine may have malformations of fat, bone, or the membranes (the meninges) that cover the spinal cord. Many of these neural tube defects require surgery in childhood. People with this type of spina bifida may have weakness of the legs and trouble with bowel and bladder control. These issues may change or progress as children grow. It is important to have close communication with doctors to minimize these changes as much as possible. Meningocele occurs when the meninges protrude through the spine and cause a sac of spinal fluid on the back. This fluid is typically only around the brain and spine, but a problem with the bony covering over the spine allows it to poke out. The malformation contains no nerves and may or may not be covered by a layer of skin. Individuals with meningocele may have minor symptoms.Myelomeningocele is the most severe form of spina bifida. A portion of the spinal cord or nerves are exposed in a sac through an opening in the spine that may or may not be covered by the meninges. The opening can be closed surgically while the baby is in utero or shortly after the baby is born. Most people with myelomeningocele experience changes in brain structure, leg weakness, and bladder and bowel dysfunction. Myelomeningocele is often called a "snowflake condition" because no two people with the condition are the same. Typically, if the opening in the spine is lower down the back, the person will experience less symptoms. People with myelomeningocele require close follow-up with physicians throughout their childhood and lifespan to maximize their function and prevent complications like kidney failure.Complications of spina bifida may include: Abnormal sensation or paralysis, which mostly occurs with closed neural tube defects and myelomenin

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