Widening of the interhemispheric fissure in an infant: causes, consequences, what to do?

Causes

During an examination of the child’s brain, doctors identify various pathologies and also pay attention to the size of the interhemispheric fissure. The distance is an anatomical feature of the newborn; it can be considered acceptable only if it is less than 3 mm. The rate of expansion of the interhemispheric fissure in an infant depends on his age. From birth to six months it should be from three to four millimeters. If the deviation is almost imperceptible, then it is necessary to periodically carry out diagnostics. Well, if the expansion of the interhemispheric fissure in a baby is 7-4 mm or more, then urgent treatment is necessary.

Etiology, pathogenesis, localization

The human brain is affected by various types of neoplasms, but neoplasms of a lipoid nature are very rare: only 0.5% of registered cases of oncopathology in the cranial cavity.

Usually a woman or man lives quietly, raises children, goes to work and does not know about the lump growing in the head. Thanks to its slow growth, the disease remains hidden. It is discovered by chance, for example, during an examination for another disease.

If the tumor reaches a significant size, the first symptoms appear. They force a person to make an appointment with a doctor and undergo an examination.

Lipomas found in the central nervous system are considered congenital by doctors and are explained by a failure of fetal development with the migration of primary lipocytes into the embryonic nervous system. Since it occupies an axial position closer to the dorsal side of the embryo, lipomas are usually detected in the middle position and on the dorsal side of the brain.

According to the place of development, experts distinguish the following types of tumor:

• interhemispheric lipoma (corpus callosum);
• lipoma of the interhemispheric fissure.

Occasionally, a tumor is recorded in the quadrigeminal cistern.

The corpus callosum, as the largest commissure connecting the anterior hemispheres, often becomes the site of formation of pericallosal lipoma of the brain.

Falx lipoma, or falx cerebri, is isolated (falx is a part of the leaf of the outermost meninges, shaped like a sickle and extending into the gap between the cerebral hemispheres).

The causes of lipomatosis occurring in the central nervous system have not been fully elucidated. The formation and increase in the volume of wen can be caused by:

1. Congenital factors
   :
   a tendency to develop cancer pathology, transmitted at the genetic level,
2. disturbance of embryogenesis and developmental anomalies.
3. Acquired factors
   :
   lipid metabolism disorder due to poor nutrition;
4. influence on the body of chemical agents and radio radiation;
5. heavy smoking, alcohol abuse, drug addiction;
6. dysfunction of endocrine organs;
7. suppression of the body's immune system, insulin-dependent diabetes;
8. trauma, inflammation (meningitis, encephalitis), neuroinfections.

Signs

In almost all cases, when an enlarged gap is detected in a newborn, parents wonder how to treat it. However, if the widening of the gap is observed to a small extent, then no treatment is needed. Also, therapy is not necessary if the baby does not show other signs that bother him. If symptoms that accompany the clinical picture of a particular disease are identified, the necessary medications will be prescribed. For example, if a newborn shows signs of rickets, and he lives in a climate area where there is a lack of light, then the necessary vitamin complexes will be prescribed.

If symptoms are identified that indicate the development of intracranial pressure, the necessary diuretics will be prescribed. You also need to take potassium supplements in parallel, then this will prevent the development of hypokalemia and hypomagnesemia.

The specialist may also prescribe certain vascular drugs that are designed to improve cerebral circulation, and drugs with a calming effect before bed. All this is necessary only if there are alarming symptoms that indicate neurological problems.

Clinical picture

The tumor does not produce symptoms for many years. However, its gradual growth presses and pushes apart the surrounding brain structures in the unchanged volume of the cranium. As a rule, they easily adapt to this pressure, since a lipoma is a formation of soft consistency.

But if it reaches large sizes, then neighboring structures can no longer function normally. This becomes the cause of the first complaints of patients, as well as objective symptoms.

Symptoms common to brain tumor pathology

General symptoms consist of signs of increased pressure in the cranial cavity and focal symptoms.

The type of focal symptom depends on the location of the wen (gap between the hemispheres, quadrigeminal, falx).

Liqueur hypertension (hypertensive-hydrocephalic syndrome) manifests:

• general symptoms
  (complaints of dizziness, increasing cephalalgia in the morning, nausea, vomiting);
• autonomic dysfunction
  (sudden changes in blood pressure, slight tremors of the limbs, loss or suppression of appetite, intestinal dysfunction);
• movement disorders
  (obsessive movements, attacks of epileptic seizures);
• mental disorders
  (decreased memory, attention function, difficulty falling asleep, sleep duration at night, increased irritability, slow reactions, apathy).

Symptoms depending on the location of the tumor

The clinical picture differs depending on the location of the lipoma:

1. an interhemispheric
   lipoma (pericallosal) can penetrate into the 3rd ventricle (located under the callous body), as well as into the paired lateral ones. The spaces of the ventricles of the brain contain cerebrospinal fluid, so when they are damaged, symptoms of high pressure in the cranial cavity, as well as signs of hypothalamic insufficiency, vary. Patients complain of hearing continuous ringing or knocking, seeing a glow (halo) over objects, and making uncontrolled movements of their limbs.
2. 
   Due to its localization, lipoma of the interhemispheric fissure Its presence is manifested by a severe decrease in vision, hearing, and frequent and sharp fluctuations in blood pressure. Intense pain, insomnia, weakness, and poor memory constitute the range of complaints of patients.
3. Falx
   lipoma becomes the causative factor of persistent cephalalgia in the forehead. Patients feel tightness, a lump in the throat, tremors of the left arm and leg.
4. A fatty tumor of the frontal lobe
   always causes sudden changes in the psyche and dysfunction of vital centers.
5. The lipoma, located near the epiphysis
   , blocks the outflow of cerebrospinal fluid from the 3rd ventricle as it grows. The result is the formation of pronounced hydrocephalus.

Lipoma on MRI - sagittal plane

Impaired blood supply is fraught with the formation of a stroke. It is especially alarming if the patient’s vomiting becomes persistent, there is a feeling of double vision, the patient is drowsy, and consciousness is depressed.

The main thing is the mode

It is worth noting that sleep problems in a newborn should be treated not through the use of medications, but only by normalizing the daily routine. It is necessary that the newborn be in the fresh air every day, and his room should always be ventilated; the nursery should be a little cool and fresh, and not hot and stuffy. You need to study how calm the environment is in your home: is there constant screaming, loud music, etc. After all, these factors can have a negative impact on the child’s psyche, so they should not exist.

Diagnostics

As a rule, it is on the conditions of a child’s development in the very first years of life that his future life will depend. Further development depends entirely on how strongly the growing person’s senses are developed: vision, smell, touch and hearing.

An interhemispheric fissure is formed in all infants. It is a consequence of the special structure of the human body. In medical practice, it can be natural (physiological) and not require increased attention, or with deviations, which indicates the accumulation of fluid between the hemispheres of the brain.

The key to better treatment of any disease is its timely diagnosis. Thus, to determine pathologies and disorders in the functioning of the brain in an infant, doctors conduct a number of diagnostic studies that can establish the current picture of everything that is happening in the small organism.

What is a brain lipoma?

This is a tumor structure formed by lipocytes (“fat cells” in Latin). They get out of control and begin to multiply (divide) frequently. As a result, there are more of them than are needed in a particular place. A tumor is emerging.

Lipoma is a benign brain tumor; it grows very slowly, does not grow through nearby structures (however, it gradually compresses them), does not metastasize, and does not turn into cancer.

Pericallosal lipoma of the brain on MRI

Neurosonography - what is it?

The best method for diagnosing the expansion of interhemispheric bones is neurosonography. This process is the same ultrasound examination (ultrasound), but only targeted and more aimed at studying the structures of the brain and everything connected with it. It provides a unique opportunity to study the internal space of the baby’s skull, establishing the degree of divergence of his head bones.

The bottom line is that ultrasound allows us to draw conclusions regarding the presence of certain pathologies in the baby’s skull associated with the discrepancy of the bones at the crown. Abnormalities detected by ultrasound include even those that were detected at the very beginning of a child’s life, while still in the womb.

What needs to be done in this situation and what will be the treatment?

Dr. Komarovsky says the following about the expansion of the interhemispheric fissure in infants: if the size of the expansion is insignificant, then treatment in this case is not necessary, since there is a high probability that it will disappear on its own with age. Also, therapy is not required if widening of the interhemispheric fissure is the only factor of concern. However, it will be necessary to have your doctor check you up from time to time.

Medicines are prescribed when additional symptoms appear that are characteristic of a particular disease. So, if a child lives in harsh climatic conditions with a lack of sunlight, or he has signs of rickets, he is prescribed vitamin D. If the symptoms indicate the development of intracranial pressure in the child, the doctor prescribes diuretics that cause the outflow of excess fluid from the brain. At the same time, medications containing potassium and magnesium are prescribed.

The effectiveness of drug treatment

If the baby has signs of neurological disorders, the doctor may prescribe vascular drugs, the effect of which is aimed at improving cerebral circulation, as well as sedatives for a good night's sleep for the child. But before you start treating a child’s troubled sleep with drugs, you first need to analyze the general atmosphere in which he lives and the causes of the problems. The problem can be solved without the help of medications, by normalizing the child’s daily routine and eliminating irritants.

If the increase in the interhemispheric fissure of the infant occurs as a result of infection, then in this case the doctor prescribes a course of treatment with antibiotics. Thus, the conclusion about the expansion of the interhemispheric fissure in a child after undergoing an ultrasound is simply a statement of fact if the indicator is only slightly higher than the norm.

The consequences of widening the interhemispheric fissure in infants are quite different. In most cases, it leads to developmental delays. This is why it is so important to start treatment as soon as possible, if necessary. It is prescribed on the basis of a specific diagnosis made not only based on the results of neurosonography, but also on the basis of certain complaints and changes in the child’s behavior.

How correctly a child’s organs and their systems are developed at the time of birth determines how he will adapt to life in the future and what his health will be like. It is for this reason that it is important to promptly identify all existing deviations and, if possible, eliminate them.

Interhemispheric fissure in infants: normal indicators, diagnostic methods

The size of the interhemispheric fissure is individual for each baby, but it should not exceed three millimeters.

Among the most accurate diagnostic procedures relating to the brain for children under one year of age is neurosonography . The procedure has been known since the nineties of the last century.

This is the same ultrasound, and the opportunity to examine the intracranial space is made possible by the fontanelles that every baby has. The sensor is lubricated with a special gel that ensures better glide over the baby’s head, and it is applied to these natural holes in the baby.

Ultrasound can detect serious brain pathologies or exclude them, as well as answer the question of why the interhemispheric fissure is enlarged. This study is inexpensive, very simple, does not require special training, but is quite informative. It makes it possible to identify even those disorders that arose in the prenatal period.

Enlargement of the gap between the hemispheres and the subarachnoid space in an infant: causes and consequences

The main reasons for the expansion of the interhemispheric fissure and subarachnoid cavity are:

• mother's illnesses during pregnancy;
• surgical delivery (caesarean section);
• accumulation of fluid between the hemispheres of the brain.

If this gap widens, the baby needs to be monitored: it is important to monitor whether it is expanding even more.

An urgent consultation with a pediatric neurologist is necessary if the child also has:

• sleep is disturbed;
• constant excessive stimulation;
• gets scared and screams from sharp sounds;
• often vomits like a fountain;
• a very serious sign of a disorder in the nervous system of an infant is squint and different pupils;
• excessive increase in head circumference;
• fontanelles protrude and slowly overgrow;
• eyes “roll out” or roll so that the white of the eye is visible;
• there are convulsions and frequent twitching of the chin and limbs;
• nosebleeds;
• marble patterns on the dermis;
• becomes restless to changes in atmospheric pressure.

  Strabismus and different pupils in a child, as a sign of widening of the interhemispheric fissure

The expansion of the gap between the hemispheres and the subarachnoid space is not an independent disease, but only a symptom of some neurological pathologies, such as hydrocephalus (increased fluid content in the interventricular space) or intracranial hypertension.

Brain abnormalities, hemorrhages, cysts, and brain tumors may also be detected.

Not all of these diagnoses are dangerous, but children with such symptoms need to be constantly monitored.

A cyst in the brain of an infant is nothing more than a small bubble that is filled with fluid. Such a baby does not need treatment, but the growth of these cysts must be monitored.

Doctors are often concerned about a larger than average head size. But this does not mean that every such child will have a serious pathology. Large head sizes can be due to many reasons. For example, many parameters in our body are associated with heredity. If dad, mom or immediate relatives wear a size 60 hat, then why can’t the child have a head circumference larger than most of his peers.

The subrachnoid space is the cavity between the meninges of the brain and spinal cord. This cavity contains cerebrospinal fluid and cerebrospinal fluid. Normally, it contains about 140 ml of cerebrospinal fluid flowing from the fourth ventricle of the brain through special openings.

The subarachnoid cavity expands parallel to the circumference of the head. At the same time, the fontanelles protrude, and the timing of their overgrowth is delayed. If there is a local expansion of this space, this means that the circulation of the cerebrospinal fluid is impaired.

If such deviations are found in a child with an enlarged interhemispheric fissure, do not immediately panic. Most minor deviations in children mean absolutely nothing, because the child’s brain is actively developing during this period. If the specialist’s conclusions seem doubtful, you should undergo another ultrasound examination in another clinic, where these conclusions will either be confirmed or refuted.

Child neurology is a fairly young science, which is now constantly faced with problems of varying complexity. This is both a lack of high-quality equipment and a lack of well-trained specialists. Despite this, you should not take any doctor’s conclusions with hostility, because this is nothing more than just an opportunity to make sure of the complete health of your child, and, perhaps, to begin the necessary therapy on time.

In order to promptly identify pathology, infants are constantly under the supervision of a local pediatrician. At certain stages of their development, babies under one year of age should be consulted several times by various specialists.

This list also includes a pediatric neurologist who should be visited at one, three, six and twelve months. You should not neglect these consultations, so as not to reproach yourself later. Suspicion of a brain tumor and intracranial hypertension requires immediate hospitalization, serious examination and long-term treatment. Fortunately, most of the suspicions of neurologists most often remain suspicions, but their instructions should not be ignored.

Read more about neurosonography and other methods for diagnosing such pathology

Neurosonography lasts no more than fifteen minutes, and children usually tolerate it well. Some children may sleep through the entire procedure, which does not interfere with its implementation at all. But there are very capricious little ones who cannot be forced to lie still for even a minute; they may be irritated by the sensor, the new environment, or even the doctor conducting the examination. In this case, you need to take a pacifier, a drinking bottle or your favorite toy with you. An ultrasound examination is good because it is not tied to food intake, because it is known that some children cannot be made to endure several hours without eating or drinking.

Another advantage of this procedure is that the baby is not taken away from the mother. She can be nearby and even ask the doctor questions that interest her. Sometimes a specialist needs to clarify something, for example, about how the pregnancy proceeded, what the mother was sick with before giving birth or the baby throughout life. He can learn all the necessary information from his mother, so her presence during neurosonography is simply necessary.

You can do this research from the first day of life . The data is deciphered by a pediatrician or pediatric neurologist. Only a specialist can connect research data with an existing clinic and make a diagnosis.

If serious abnormalities are detected, sometimes it is necessary to resort to studies such as magnetic resonance imaging and computed tomography. These techniques are expensive and take much more time, so they are performed only after questionable or alarming results of neurosonography.

MRI is by far the most accurate of all known studies. With its help you can see a layer-by-layer image of the required area. But examining infants in this way is very difficult: during the procedure you need to lie still, but how can you require this from a child under one year old? But there are times when this research cannot be done without. If there is a serious need for an MRI, the baby will have to be given anesthesia.

Treatment methods

If the enlargement is slight, no treatment is carried out, but it is still necessary to examine the child periodically. If during diagnostic procedures an accumulation of fluid is detected in the subarachnoid cavity, treatment is prescribed.

Typically the list of prescribed drugs includes:

• substances that help remove excess fluid from the body;
• potassium and magnesium containing drugs;
• B vitamins;
• vitamin D3, if it turns out that the baby’s body lacks it.

If a strong and progressive enlargement of the subarachnoid cavity is detected, then all therapy consists of eliminating the cause that caused this disorder. If intracranial pressure is increased, then medications are prescribed to help reduce it (diuretics). If an infection has led to the pathology, then the small patient is prescribed a course of antibiotic treatment.

hydrocephalus

If a baby is diagnosed with hydrocephalus without a significant enlargement of the ventricles and head as a whole, it should be remembered that in four out of five cases, it can compensate itself by the age of two. But you shouldn’t rely too much on this opinion, and if this diagnosis was confirmed by ultrasound in several clinics, then it is better to undergo the necessary treatment.

Hydrocephalus is dangerous because if the head has become greatly enlarged under fluid pressure, its size will not return to normal even after surgical treatment. Vision may also decrease to the point of blindness, the child may be delayed in development, speech and other important body functions may be impaired.

If treatment for this formidable disease is started in time, then its outcome is quite favorable.

Thus, if a child has an enlarged gap between the hemispheres, but develops normally, sleeps peacefully, and is not too restless, most likely there is no reason to worry. But you should not neglect consulting a doctor.