What is the diagnosis for a 21-year-old primigravida (gravida 1, para 0) at 20 weeks gestation with a large calvarial defect, meningocele, and cerebellar hypoplasia, presenting with hypertension and obesity?

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Differential Diagnosis for Fetal Anomaly

  • Single most likely diagnosis
    • Anencephaly: This condition is characterized by the absence of a major portion of the brain, skull, and scalp, which is consistent with the ultrasonography findings of a large defect in the calvaria and meninges, with only a small cerebellum and brainstem.
  • Other Likely diagnoses
    • Encephalocele: This is a neural tube defect where the brain and meninges protrude through a defect in the skull, which could be considered given the description of the calvaria and meninges defect.
    • Acrania: A condition where there is a partial or complete absence of the skull, but with normal brain formation, which might be considered if the brain tissue is more preserved than in anencephaly.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Amniotic band syndrome: Although less likely, this condition involves fetal entrapment and constriction by amniotic bands, which can cause various anomalies, including cranial defects. Missing this diagnosis could lead to further complications.
    • Intrauterine infection: Certain infections can cause severe fetal anomalies, including cranial defects. Identifying and managing such infections is crucial for the health of both the fetus and the mother.
  • Rare diagnoses
    • Cranial meningocele: A rare condition where the meninges herniate through a defect in the skull, which could be a consideration but is less common than anencephaly or encephalocele.
    • Iniencephaly: A rare neural tube defect characterized by the upward curvature of the cervicothoracic spine and anencephaly, which might be considered given the severe nature of the described anomalies.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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