Oct. 25, 1995 Neonatal Cranial Ultrasound
Becky Carpenter, M.D.
Technique
Tools
Transducer
7.5 or 5.0 mHz
Small footprint
Gel, and gel warmer
Videotape
Approach
Standard
Anterior Fontanelle (AF)
Optional
Posterior Fontanelle (PF) Ð occipital horns
Post Auricular (PA) Ð posterior fossae
Trans Temporal (TT) Ð foramen of Monro
circle of Willis
Standard Views
Coronal
Orbital roofs
Anterior frontal horns
Germinal matrix
Posterior fossae
Trigones
Occipital
Sagittal
Right sylvian fissure
Right periventricular
Right lateral ventricle
Right caudoÐthalamic
Midline
Left caudoÐthalamic
Left lateral ventricle
Left periventricular
Left sylvian fissure
Important Points
Symmetry
Gel
OffÐmidline
Checklist
Ventricular size and contents
Germinal matrix
Cerebral parenchyma
Cerebellar parenchyma
ExtraÐaxial space
Development/anomalies
Vascular pulsations
IntraCranial Hemorrhage (ICH)
Prematurity
26Ð32 week EGA
880Ð1830 grams
Prevalence 30Ð50%
Occurrence
50% Ð 24 hours
90% Ð 72 hours
Progression
40%
Within 3 days
Bleeding disorders
Screening Ultrasound Ð Infants Less Than 33 wks EGA
Conservative
Scan 1 Ð 3 to 5 days after birth (onset)
Scan 2 Ð 4 to 5 days later (progression)
Scan 3 Ð 7 to 10 days later (sequelae)
Liberal
Scan 1 Ð 1 week of life
Scan 2 Ð 1 month of life
Other Indications
Intrauterine stress
Pneumothorax
Drop in hematocrit
Pressure instability
Hypoxia
Apneic/bradycardic spells Neurologic signs
General deterioration
Sonographic Findings of ICH
Germinal matrix hemorrhage
Echogenicity Ð hyper
Asymmetry
Bulge into ventricle
Enlarged choroid anteriorly
Intraventricular hemorrhage
Blood/CSF level
Blood cast
Lumpy choroid
Asymmetric choroid
Choroid in occipital horn
Pitfalls
Prematurity
Calcar avis
IntraÐParenchymal Echogenicity (IPE)
Descriptive terminology
NonÐspecific
Ischemia/edema
Hemorrhage
Normal vs Abnormal
Signs of abnormality
Asymmetry
Coarseness
Irregular margins
Persists on all views
Periventricular Leukomalacia (PVL)
Pathologic diagnosis
White matter necrosis
Ischemic/hypoxic insult
PreÐ or postÐnatal
Prematurity
Bilateral, symmetric
Periventricular
Superimposed hemorrhage
High morbidity/mortality
Neurologic sequelae
Sonography
Limited sensitivity
Posterior fossae hemorrhage (PFH)
Intracerebellar vs extracerebellar
Signs
Loss of landmarks
Asymmetry
Echogenicity Ð hyper or hypo
Enlarged ventricles
Prevalence
25% autopsy series
Evolution
Germinal matrix hemorrhage
Cysts
Intraventricular hemorrhage
Clot retraction
Fibrin strands
Ventriculomegaly
Intraparenchymal hemorrhage/ischemia/PVL
Disappearance
Ventriculomegaly
Cystic changes
Cavitation
Porencephaly
Prognosis
Germinal matrix hemorrhage
Good
Intraventricular hemorrhage
Good, to variable
Ventriculomegaly
Intraparenchymal hemorrhage/PVL
Variable
80% some deficit
Porencephaly
Hemiparesis
Cystic PVL
100% cerebral palsy
50% Retardation
References
Ultrasonography of Infants and Children
text by Teele, Rita MD and Share, Jane MD
Saunders 1991, Chapter 1, pages 1Ð56
Diagnostic Ultrasound
text by Rumack, Carol MD; Wilson, Stephanie MD, Charboneau, William MD
Mosby Year Book 1991, Vol 2, Chapter 53, pages 1009Ð1044
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