Encephalomalacia : Brain ischemia or inflammation

Porencephaly : Focal destruction of brain tissue

Hydranencephaly : Complete destruction of cerebral hemispheres

Intracranial bleeding has variable appearance

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  Nonperfused intracranial mass of varying echogenicity

  
  
  
  
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    Initially echogenic, iso- to hypoechoic over time

  
  
  
  
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  Irregular, bulky choroid plexus due to adherent clot

  
  
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  Echogenic, irregular ependyma (ventricular lining)

  
  
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  Fluid-fluid level in ventricles

Hydrocephalus from obstructed CSF flow due to ependymal thickening and layering clot

Normal landmarks may be obscured by clot or tissue injury

Porencephaly develops at site of parenchymal bleed

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  Resorption of clot/damaged tissue leaves anechoic parenchymal cyst connected to adjacent ventricle

Intracranial tumor may be confused with clot but has internal blood flow and shows rapid growth

Holoprosencephaly may be confused with hydranencephaly but falx is missing; face often abnormal

Any echogenic material in frontal horns is suspicious for clot

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  Choroid plexus does not extend anterior to caudothalamic groove

High-resolution transvaginal US if cephalic presentation

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  Features may be very subtle, especially if associated with acute hypotensive episode

  
  
  
  
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    Maternal trauma, abruption, post fetal intervention, after monochorionic twin demise

  
  
  
  
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  Assess at time of injury and again within 7-10 days

  
  
  
  
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    Signs of encephalomalacia take time to develop

  
  

Use color Doppler to look for vascular malformation as potential cause