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2012-07-18-10 Blake's pouch cyst ©Elena Andreeva www.TheFetus.net


Blake's pouch cyst

Elena Andreeva, MD; Natalia Odegova, MD
 
Moscow regions Research Institute of Obstetrics and Gynecology, Medical-Genetics Department, Moscow, Russia.


Case report:

A 25-year-old G1 P0 with non-contributive family and personal history was referred to our center at 24 weeks and 30 weeks of gestation. We found Blake’s pouch cyst. No other abnormalities were detected.
The baby boy was born at term, weight of 3500 gr, height of 53 cm, Apgar 7/9 with no neurological symptoms. At the age of 3 months, MRI was performed and confirmed the diagnosis. The child develops without neurological disease.

Blake's pouch cyst (BPC) has been considered a pathological entity deriving from abnormal development of the posterior membranous area of the fetal brain. This pathology is characterized by normal anatomy and size of the vermis; mild/moderate anti-clockwise rotation of the vermis; normal size of the cisterna magna.

Image 1: 24 weeks. Normal profile of fetus




Image 2: 24 weeks. Normal appearance of cerebellum in the upper part


Image 3, 4:  Abnormal appearance of the cerebellum in the lower part (the classic keyhole sign) at 24 and 30 weeks



Image 5, 6: 24 weeks. Brain stem (1); inferior medullary vellum (2); a large gap between the inferior vermis and brain stem(3), rotation of vermis (4) with normal size



Image 7, 8: 3D and Multiplanar three-dimensional (3D) ultrasound was used to enhance the assessment of the Blake's pouch cyst and its relationships with the vermis and the posterior fossa. The image showed septum pellucidum (1),
corpus calosum (2); Thalamus(3);Vermis cerebellum (rotation); Fourth ventricle is open(4); the Blake's pouch cyst (5)



Image 9: (1)mid brain with pons (brain stem); (2)Vermis; (3)oriented line for assessing the topography of the vermis; (4)cavum vergae (continuation of cavum septum pellucidum); (5)Corpus callosum; (6) arrow showing inferior medullary vellum. Large gap between the inferior vermis and brain stem.


Image 10, 11: 3D reconstruction scan showing the position of the Blake's pouch cyst




Image 12, 13: The normal brain structure (left) and the elevation of the cerebellum when the Blake's pouch cyst exists(right) enlarging the posterior fossa.
 

Video:



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