prenatal ultrasound open lip schizencephaly fetal brain coronal ultrasound

schizencephaly prenatal ultrasound

ISUOG fetal brain ultrasound schizencephaly open lip prenatal diagnosis

https://www.isuog.org/education/visuog/obstetrics/brain/cort…

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mkdir -p "/tmp/workspace/open_lip_schizencephaly_ppt/src" "/tmp/workspace/open_lip_schizencephaly_ppt/assets" "/tmp/workspace/open_lip_schizencephaly_ppt/output" && python /tmp/skills/shared/scripts/fetch_images.py "https://cdn.orris.care/cdss_images/564e92d819277961e940e3fed0427590d2c93cffca9924b3630d0547f27f7a44.png" > "/tmp/workspace/open_lip_schizencephaly_ppt/assets/fetch_result.json"

python -c "import json,base64; from pathlib import Path; p=Path('/tmp/workspace/open_lip_schizencephaly_ppt/assets/fetch_result.json'); d=json.loads(p.read_text()); x=d[0]; Path('/tmp/workspace/open_lip_schizencephaly_ppt/assets/mri_schizencephaly.png').write_bytes(base64.b64decode(x['base64'].split(',',1)[1])); print(x.get('error'), len(x['base64']))"

python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/open_lip_schizencephaly_ppt/src/create_deck.py') p.write_text(r'''from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.text import MSO_AUTO_SIZE from PIL import Image OUT='/tmp/workspace/open_lip_schizencephaly_ppt/output/Antenatal_USG_Open_Lip_Schizencephaly.pptx' MRI='/tmp/workspace/open_lip_schizencephaly_ppt/assets/mri_schizencephaly.png' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] # palette NAVY=RGBColor(13,36,59); TEAL=RGBColor(34,130,139); AQUA=RGBColor(92,193,190); PALE=RGBColor(237,247,246); WHITE=RGBColor(255,255,255); INK=RGBColor(28,45,59); MUTED=RGBColor(91,109,119); CORAL=RGBColor(218,92,82); GOLD=RGBColor(239,181,69); LT=RGBColor(247,250,251); GREY=RGBColor(210,220,225) def fill(shape,c): shape.fill.solid(); shape.fill.fore_color.rgb=c def line(shape,c=None,w=1): if c is None: shape.line.fill.background() else: shape.line.color.rgb=c; shape.line.width=Pt(w) def textbox(slide,x,y,w,h,text,size=18,color=INK,bold=False,align=PP_ALIGN.LEFT,font='Aptos',valign=MSO_ANCHOR.TOP): box=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=box.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=tf.margin_right=tf.margin_top=tf.margin_bottom=0; tf.vertical_anchor=valign for i,txt in enumerate(text.split('\n')): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=txt; p.alignment=align; p.space_after=Pt(2) for r in p.runs: r.font.name=font; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color return box def rect(slide,x,y,w,h,c,r=True): s=slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if r else MSO_SHAPE.RECTANGLE, Inches(x),Inches(y), Inches(w), Inches(h)); fill(s,c); line(s); return s def title(slide,kicker,heading,sub=''): textbox(slide,.58,.32,12,.25,kicker.upper(),10,TEAL,True) textbox(slide,.58,.62,12.1,.52,heading,25,NAVY,True) if sub: textbox(slide,.58,1.18,12,.30,sub,11,MUTED) def footer(slide,txt,pg): textbox(slide,.58,7.12,11.8,.18,txt,7,MUTED) textbox(slide,12.45,7.07,.34,.22,str(pg),9,TEAL,True,PP_ALIGN.RIGHT) def bullet_list(slide,x,y,w,h,items,size=16,color=INK): box=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=box.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=Pt(3); tf.margin_top=Pt(1) for i,item in enumerate(items): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=item; p.level=0; p.font.size=Pt(size); p.font.name='Aptos'; p.font.color.rgb=color; p.space_after=Pt(8); p._p.get_or_add_pPr().insert(0, __import__('pptx').oxml.xmlchemy.OxmlElement('a:buChar')); p._p.pPr[0].set('char','•') return box def brain(slide,x,y,w,h,open_lip=True): # stylized coronal brain and ventricle-cleft communication o=slide.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x),Inches(y),Inches(w),Inches(h)); fill(o,RGBColor(216,232,231)); line(o,TEAL,1.2) # midline ln=slide.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,Inches(x+w/2),Inches(y+.22),Inches(x+w/2),Inches(y+h-.22)); ln.line.color.rgb=TEAL; ln.line.width=Pt(1) # ventricles for dx in [w*.31,w*.53]: v=slide.shapes.add_shape(MSO_SHAPE.ARC,Inches(x+dx),Inches(y+h*.36),Inches(w*.18),Inches(h*.23)); fill(v,WHITE); line(v,TEAL,1) if open_lip: # fluid cleft to cortex right side pts=[(x+w*.68,y+h*.45),(x+w*.94,y+h*.24),(x+w*.99,y+h*.34),(x+w*.79,y+h*.54)] free=slide.shapes.build_freeform(Inches(pts[0][0]), Inches(pts[0][1])); free.add_line_segments([(Inches(a),Inches(b)) for a,b in pts[1:]], close=True); sh=free.convert_to_shape(); fill(sh,RGBColor(255,255,255)); line(sh,CORAL,2) textbox(slide,x+w*.58,y+h*.07,w*.38,.25,'Cleft to subarachnoid space',8,CORAL,True,PP_ALIGN.CENTER) return o # 1 title s=prs.slides.add_slide(blank); s.background.fill.solid(); s.background.fill.fore_color.rgb=NAVY # decorative circles for x,y,d,c in [(9.7,.4,3.1,TEAL),(10.7,1.15,2.15,AQUA),(9.2,5.72,1.6,RGBColor(23,78,94))]: q=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x),Inches(y),Inches(d),Inches(d)); fill(q,c); line(q) textbox(s,.7,.83,7.7,.3,'FETAL NEUROSONOGRAPHY',13,AQUA,True) textbox(s,.7,1.35,8.0,1.42,'Antenatal USG of\nOpen-lip Schizencephaly',32,WHITE,True) textbox(s,.72,3.05,6.9,.72,'Recognition of the gray matter-lined cortical cleft, focused neurosonography and appropriate next steps.',16,RGBColor(211,233,233)) rect(s,.72,4.42,3.3,.52,TEAL); textbox(s,.92,4.57,2.9,.18,'Teaching presentation',11,WHITE,True,PP_ALIGN.CENTER) brain(s,9.1,2.65,2.9,2.9,True) textbox(s,.72,6.72,7,.25,'Educational content - correlate with expert fetal medicine assessment',9,RGBColor(185,211,214)) footer(s,'Sources: ISUOG VISUOG Schizencephaly; ISUOG Patient Information (Jan 2024).',1) # 2 definition s=prs.slides.add_slide(blank); title(s,'Core concept','What is open-lip schizencephaly?','A malformation of cortical development, not simply a “cystic lesion”.') rect(s,.6,1.72,5.82,4.78,PALE); textbox(s,.95,2.02,5.12,.35,'Definition',20,NAVY,True) bullet_list(s,.98,2.57,5.0,3.5,["A congenital, full-thickness cleft through the cerebral mantle.","The cleft connects the lateral ventricle to the subarachnoid space.","Its walls are lined by dysplastic gray matter, continuous with cortex.","In open-lip type (type II), the lips are separated by CSF."] ,16) brain(s,7.65,1.88,4.25,4.25,True) rect(s,7.32,6.23,4.93,.42,RGBColor(253,239,236)); textbox(s,7.54,6.35,4.5,.16,'Key distinction: gray matter lining',12,CORAL,True,PP_ALIGN.CENTER) footer(s,"Sources: Bradley & Daroff's Neurology in Clinical Practice, ch. 40; Grainger & Allison's Diagnostic Radiology, p. 1982.",2) # 3 pathogenesis s=prs.slides.add_slide(blank); title(s,'Mechanism','Developmental basis and classification') rect(s,.65,1.75,3.82,4.8,LT); textbox(s,.95,2.05,3.15,.33,'Neuronal migration disorder',18,NAVY,True) textbox(s,.95,2.58,3.05,1.35,'Disordered cortical development results in a cleft that retains a dysplastic gray matter lining.',17,INK) textbox(s,.95,4.38,3.05,.35,'Often associated with',14,TEAL,True) bullet_list(s,.96,4.78,3.1,1.15,['Polymicrogyria','Callosal anomalies','Absent septum pellucidum'],13) # classification panels for x,lab,op in [(5.0,'CLOSED-LIP\nType I',False),(8.8,'OPEN-LIP\nType II',True)]: rect(s,x,1.75,3.1,4.8,PALE if op else RGBColor(244,247,248)); textbox(s,x+.22,2.04,2.65,.5,lab,16,NAVY,True,PP_ALIGN.CENTER) brain(s,x+.65,2.75,1.85,1.85,op) textbox(s,x+.28,4.93,2.55,.66,'Fused lips\nUsually very difficult antenatally' if not op else 'Separated lips with CSF\nMore recognizable antenatally',13,CORAL if op else MUTED,False,PP_ALIGN.CENTER) footer(s,"Sources: ISUOG VISUOG Schizencephaly; Bradley & Daroff's Neurology in Clinical Practice, ch. 40.",3) # 4 where/when s=prs.slides.add_slide(blank); title(s,'Screening context','When to suspect it on antenatal ultrasound') rect(s,.65,1.75,12.0,.74,NAVY); textbox(s,.93,1.97,11.45,.24,'Most often recognized at the mid-trimester anomaly scan when the cleft is widely open.',16,WHITE,True,PP_ALIGN.CENTER) for x,num,head,body in [(0.8,'01','Screening planes','Unexpected intracranial hypoechoic/cystic-appearing defect.'),(4.55,'02','Targeted neurosonography','Assess the cerebral mantle in multiplanar views.'),(8.3,'03','Diagnostic clue','Demonstrate a cleft from ventricle to subarachnoid space.')]: c=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x),Inches(3.0),Inches(.72),Inches(.72)); fill(c,TEAL); line(c); textbox(s,x,3.22,.72,.18,num,12,WHITE,True,PP_ALIGN.CENTER) textbox(s,x,4.0,3.05,.28,head,17,NAVY,True); textbox(s,x,4.45,3.05,.7,body,14,INK) rect(s,.9,6.0,11.5,.45,RGBColor(255,246,229)); textbox(s,1.1,6.14,11.05,.18,'Closed-lip schizencephaly is often not detectable prenatally.',13,RGBColor(135,94,15),True,PP_ALIGN.CENTER) footer(s,'Source: ISUOG VISUOG Schizencephaly; ISUOG Patient Information (Jan 2024).',4) # 5 scan technique s=prs.slides.add_slide(blank); title(s,'Technique','Focused fetal neurosonography: practical approach') # flow steps=[('1','Confirm the defect','Axial transventricular and transthalamic views.'),('2','Add coronal views','Best to trace ventricular-to-surface communication.'),('3','Add sagittal views','Assess midline, corpus callosum and extent.'),('4','Use color Doppler','Exclude a vascular structure when relevant.')] for i,(n,h,b) in enumerate(steps): x=.74+i*3.12; rect(s,x,2.0,2.72,3.4,LT); c=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x+.18),Inches(2.2),Inches(.55),Inches(.55)); fill(c,TEAL); line(c); textbox(s,x+.18,2.37,.55,.16,n,11,WHITE,True,PP_ALIGN.CENTER) textbox(s,x+.2,3.05,2.28,.62,h,16,NAVY,True); textbox(s,x+.2,4.0,2.28,.75,b,13,INK) if i<3: a=s.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,Inches(x+2.73),Inches(3.69),Inches(x+3.07),Inches(3.69)); a.line.color.rgb=TEAL; a.line.width=Pt(2) rect(s,.85,6.1,11.62,.45,PALE); textbox(s,1.05,6.23,11.2,.16,'Document laterality, location, dimensions, ventricular size and associated intracranial/extracranial findings.',12,TEAL,True,PP_ALIGN.CENTER) footer(s,'Source: ISUOG VISUOG Schizencephaly. Local protocols determine acquisition and reporting standards.',5) # 6 sonographic findings s=prs.slides.add_slide(blank); title(s,'Ultrasound findings','The pattern to recognize') rect(s,.68,1.72,5.3,4.9,PALE); brain(s,1.52,2.12,3.55,3.55,True) textbox(s,1.0,5.96,4.65,.28,'Schematic coronal concept',13,TEAL,True,PP_ALIGN.CENTER) rect(s,6.32,1.72,6.25,4.9,LT); textbox(s,6.68,2.04,5.35,.25,'Checklist',19,NAVY,True) bullet_list(s,6.7,2.65,5.25,3.3,['CSF-filled cortical cleft communicating with lateral ventricle and subarachnoid space.','Cleft margins may appear irregular because of abnormal cortical development.','Unilateral or bilateral lesion; assess location and size.','Look for absent septum pellucidum, callosal anomaly, ventriculomegaly and other cortical anomalies.'],15) footer(s,'Sources: ISUOG VISUOG Schizencephaly; Grainger & Allison’s Diagnostic Radiology, p. 1982.',6) # 7 differentials s=prs.slides.add_slide(blank); title(s,'Differential diagnosis','Do not label every cystic-appearing defect as schizencephaly') cols=[('Open porencephalic cyst','May communicate with ventricle and surface, but lacks a gray matter-lined cleft.'),('Arachnoid / intracranial cyst','Usually displaces adjacent brain rather than traversing the cerebral mantle.'),('Lobar holoprosencephaly / septo-optic dysplasia','Midline abnormality pattern; may overlap with absent septum pellucidum.'),('Destructive lesion / infarction','Cavity may be white matter-lined rather than dysplastic gray matter-lined.')] for i,(h,b) in enumerate(cols): x=.7+(i%2)*6.15; y=1.78+(i//2)*2.36; rect(s,x,y,5.74,1.88,LT); textbox(s,x+.28,y+.25,5.1,.28,h,16,NAVY,True); textbox(s,x+.28,y+.73,5.1,.75,b,13,INK) rect(s,.8,6.52,11.65,.34,RGBColor(253,239,236)); textbox(s,1.03,6.61,11.15,.14,'Prenatal certainty about gray matter lining may be limited: fetal MRI is a useful complementary test.',11,CORAL,True,PP_ALIGN.CENTER) footer(s,'Source: ISUOG VISUOG Schizencephaly.',7) # 8 MRI image s=prs.slides.add_slide(blank); title(s,'Complementary imaging','Fetal MRI can refine the diagnosis and map associated anomalies') rect(s,.68,1.65,6.2,4.98,RGBColor(18,26,38)); # picture preserve im=Image.open(MRI); ratio=im.width/im.height; maxw=5.73; maxh=4.45; dw=min(maxw,maxh*ratio); dh=dw/ratio s.shapes.add_picture(MRI,Inches(.68+(6.2-dw)/2),Inches(1.92+(4.45-dh)/2),width=Inches(dw),height=Inches(dh)) textbox(s,.85,6.35,5.85,.18,'Postnatal MRI example: gray matter-lined cleft (source figure)',8,WHITE,False,PP_ALIGN.CENTER) rect(s,7.27,1.65,5.32,4.98,LT); textbox(s,7.66,2.05,4.5,.3,'Questions MRI helps answer',19,NAVY,True) bullet_list(s,7.67,2.68,4.48,2.6,['Is the cortical cleft truly present?','What are the laterality, extent and cortical anomalies?','Are corpus callosum, septum pellucidum or hippocampi abnormal?','Are there additional brain lesions altering prognosis?'],15) textbox(s,7.67,5.75,4.35,.36,'USG and MRI are complementary, not competing.',13,TEAL,True) footer(s,"Image: Grainger & Allison’s Diagnostic Radiology, Fig. 76.21, p. 1982. Content: ISUOG VISUOG Schizencephaly.",8) # 9 workup counseling s=prs.slides.add_slide(blank); title(s,'After suspicion','Structured evaluation and counseling') items=[('Expert review','Detailed fetal neurosonography by fetal medicine / neurosonography expertise.'),('Search for associations','Systematic intracranial and extracranial survey; document associated anomalies.'),('Complementary tests','Consider fetal MRI. Discuss genetic evaluation and infection assessment when clinically indicated.'),('Counsel as a team','Fetal medicine, radiology, genetics, neonatology and pediatric neurology/neurosurgery as needed.')] for i,(h,b) in enumerate(items): x=.72+(i%2)*6.15; y=1.73+(i//2)*2.3; rect(s,x,y,5.74,1.8,PALE); textbox(s,x+.27,y+.27,5.1,.25,h,16,NAVY,True); textbox(s,x+.27,y+.73,5.12,.65,b,13,INK) footer(s,'Sources: ISUOG Patient Information (Jan 2024); ISUOG VISUOG Schizencephaly.',9) # 10 prognosis s=prs.slides.add_slide(blank); title(s,'Outcome and management','Prognosis is individualized') rect(s,.68,1.72,4.0,4.75,NAVY); textbox(s,1.03,2.05,3.22,.25,'Main prognostic drivers',19,WHITE,True) bullet_list(s,1.03,2.68,3.1,2.8,['Laterality and extent of clefts','Location and associated cortical anomalies','Additional intracranial and extracranial abnormalities','Postnatal seizures and neurodevelopment'],15,WHITE) rect(s,5.08,1.72,7.47,2.08,PALE); textbox(s,5.48,2.05,6.64,.25,'Expected spectrum',19,NAVY,True); textbox(s,5.48,2.62,6.25,.7,'From mild seizure disorder or focal motor deficit to substantial motor impairment and developmental disability.',15,INK) rect(s,5.08,4.15,7.47,2.32,LT); textbox(s,5.48,4.47,6.65,.25,'Pregnancy and delivery',19,NAVY,True); textbox(s,5.48,5.04,6.34,.84,'Obstetric care is usually standard unless other obstetric or fetal indications exist. Arrange delivery and postnatal evaluation in a setting appropriate to associated findings.',15,INK) footer(s,'Source: ISUOG VISUOG Schizencephaly. Prognosis varies with lesion pattern and associations.',10) # 11 report & takehome s=prs.slides.add_slide(blank); title(s,'Reporting and take-home','A concise conclusion for the ultrasound report') rect(s,.7,1.72,6.25,4.88,LT); textbox(s,1.02,2.06,5.57,.28,'Suggested report elements',19,NAVY,True) bullet_list(s,1.02,2.66,5.55,3.25,['Site, laterality and dimensions of cortical cleft','Communication with ventricle and subarachnoid space','Appearance of cleft margins and surrounding cortex','Ventricles, septum pellucidum, corpus callosum and other CNS findings','Extracranial survey, recommendation for fetal MRI and specialist review'],14) rect(s,7.35,1.72,5.23,4.88,NAVY); textbox(s,7.76,2.1,4.38,.31,'Take-home message',20,AQUA,True) textbox(s,7.76,2.75,4.15,2.23,'The antenatal hallmark of open-lip schizencephaly is a widely open, CSF-filled cortical cleft that connects the lateral ventricle to the subarachnoid space.',21,WHITE,True) textbox(s,7.76,5.52,4.2,.34,'Confirm with multiplanar neurosonography and assess the entire fetal brain.',13,RGBColor(206,231,232),False) footer(s,'Key sources: ISUOG VISUOG Schizencephaly; ISUOG Patient Information (Jan 2024).',11) # sources s=prs.slides.add_slide(blank); title(s,'References','Core sources used in this teaching deck') refs=["International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). VISUOG: Schizencephaly. Accessed September 2026.","ISUOG. Patient Information: Schizencephaly. Last update January 2024.","Grainger & Allison’s Diagnostic Radiology: A Textbook of Medical Imaging. Schizencephaly, Fig. 76.21, p. 1982.","Bradley and Daroff’s Neurology in Clinical Practice. Cerebrospinal Fluid Circulation Disorders, Schizencephaly section."] rect(s,.75,1.68,11.8,4.75,LT); for i,r in enumerate(refs): textbox(s,1.1,2.05+i*1.0,10.9,.56,r,15,INK) textbox(s,.78,6.74,11.6,.2,'For education only. Diagnosis, testing and counseling require individualized specialist assessment.',9,MUTED,False,PP_ALIGN.CENTER) footer(s,'References',12) prs.save(OUT) print(OUT) ''') PY python "/tmp/workspace/open_lip_schizencephaly_ppt/src/create_deck.py" && ls -lh "/tmp/workspace/open_lip_schizencephaly_ppt/output/Antenatal_USG_Open_Lip_Schizencephaly.pptx"

python - <<'PY' from pptx import Presentation p='/tmp/workspace/open_lip_schizencephaly_ppt/output/Antenatal_USG_Open_Lip_Schizencephaly.pptx' prs=Presentation(p) print('slides',len(prs.slides)) for i,s in enumerate(prs.slides,1): texts=[sh.text.strip().replace('\n',' / ') for sh in s.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()] print(i, ' | '.join(texts[:3])) PY