Citation, DOI & case data
Pregnant woman came for a routine obstetric ultrasound to investigate a possible malformation in the central nervous system of the fetus.
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Absence of brain and calvaria superior to the orbits on coronal views of the fetal head.
"Frog eye" appearance due to absent cranial bone/brain and bulging eyes. Sagital plane showing the fetal profile with no skull cap.
Anencephaly is a defect of the development of the central nervous system, and its condition is incompatible with survival. Prenatal detection of anencephaly by ultrasound is accurate and reliable at 10-14 weeks scan, in some cases earlier, but diagnosis at a very early pregnancy is still unreliable because calcification of skull is complete by 10 weeks.
Ultrasound features of anencephaly are different in the first and second trimesters. In the first-trimester "mickey-mouse" bi-lobar face are viewed and typically represents this pathology, besides, other features can be present such as an increase of amniotic fluid echogenicity, irregular head morphology, and crown-rump length significantly reduced.
In the second trimester, the typical appearance of anencephaly is the "frog eye" sign, as shown in our ultrasound images due to absent cranial bone/brain and bulging eyes. In addition, polyhydramnios may be present due to a decrease in fetal swallowing.
Start folic acid supplementation before conception and throughout the first trimester has shown a decreased risk of neural defects in almost 50% of the pregnancies.
Images: MD Jose Roberto Festugatto.
- 1. Martins Santana EF, Araujo Júnior E, Tonni G, Costa FDS, Meagher S. Acrania-exencephaly-anencephaly sequence phenotypic characterization using two- and three-dimensional ultrasound between 11 and 13 weeks and 6 days of gestation. (2018) Journal of ultrasonography. 18 (74): 240-246. doi:10.15557/JoU.2018.0035 - Pubmed
- 2. Chatzipapas IK, Whitlow BJ, Economides DL. The 'Mickey Mouse' sign and the diagnosis of anencephaly in early pregnancy. (1999) Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 13 (3): 196-9. doi:10.1046/j.1469-0705.1999.13030196.x - Pubmed
- 3. Sawsan Al-Obaidly, Jis Thomas, Mahmoud Abu Jubara, Abdullah Al Ibrahim, Mariam Al-Belushi, Najah Saleh, Zeena Al-Mansouri, Najat Khenyab. Anencephaly and obstetric outcome beyond the age of viability. (2018) Journal of Perinatal Medicine. 46 (8): 885. doi:10.1515/jpm-2017-0363
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