Neurosonography



Fig. 6.1
Diagram of the lateral skull for the common sites of cranial sonography through anterior (A), posterior (P), and mastoid (M) fontanelles





6.3.1.2 Normal Anatomy




A308051_1_En_6_Fig2_HTML.jpg


Fig. 6.2
(a and b) Coronal sonographic image (a) and schematic illustration (b) at the level of foramen of Monro through the anterior fontanelle


A308051_1_En_6_Fig3_HTML.jpg


Fig. 6.3
(a and b) Midsagittal sonographic image (a) and schematic illustration (b) through the anterior fontanelle representing the whole corpus callosum, the third and fourth ventricles, brain stem, cerebellar vermis, and cistern magna


A308051_1_En_6_Fig4_HTML.jpg


Fig. 6.4
(a and b) Right parasagittal sonographic image (a) and schematic illustration (b) at the level of the caudothalamic groove through the anterior fontanelle


A308051_1_En_6_Fig5_HTML.jpg


Fig. 6.5
(a and b) Coronal sonographic image (a) and schematic illustration (b) at the level of the bodies of the lateral and third ventricles through the posterior fontanelle


A308051_1_En_6_Fig6_HTML.jpg


Fig. 6.6
(a and b) Midsagittal sonographic image (a) and schematic illustration (b) at the level of the corpus callosum and the third and fourth lateral ventricles through the posterior fontanelle


A308051_1_En_6_Fig7_HTML.jpg


Fig. 6.7
(a and b) Oblique axial sonographic image (a) and schematic illustration (b) at the level of the third ventricle and midbrain through the mastoid fontanelle


6.3.1.3 Normal Variants and Pitfalls




A308051_1_En_6_Fig8a_HTML.jpgA308051_1_En_6_Fig8b_HTML.jpg


Fig. 6.8
Echogenic pseudolesion. (a) Posterior coronal scan through the anterior fontanelle in 1-day-old male neonate shows a triangular echogenic pseudolesion (arrow) in the left frontotemporal junction attached to adjacent sulci and a discrete, round echogenic lesion (arrowhead) in right frontal white matter apart from sulci confirmed as focal hemorrhagic infarct. (b) Left parasagittal scan through the posterior fontanelle in a 5-day-old male neonate shows a round echogenic density in the left thalamus (arrow), so-called thalamic pseudolesion. (c) On left parasagittal scan through the anterior fontanelle, thalamic pseudolesion disappeared. (d and e) Left parasagittal scan through the anterior fontanelle in a 2-day-old male neonate (d) shows a focal echogenic pseudolesion (arrow) posterior to dilated occipital horn of left lateral ventricle, and on left parasagittal scan through the posterior fontanelle (e), it disappeared


A308051_1_En_6_Fig9_HTML.jpg


Fig. 6.9
Calcar avis in a 3-day-old female neonate. (a) Coronal image shows white matter mound by compression of medial side of lateral ventricle. (b) Left parasagittal image shows intraventricular hyperechoic mass in the occipital horn of the lateral ventricle mimicking intraventricular hematoma


A308051_1_En_6_Fig10_HTML.jpg


Fig. 6.10
Sequential changes of periventricular echogenic halo. (a) Coronal image of premature male infant at 30 weeks gestational age shows symmetrical, homogeneous, and high echogenic halos in both periventricular white matters. (b) Coronal image at 41 weeks of the corrected age shows near disappearance of both periventricular echogenic halos


A308051_1_En_6_Fig11_HTML.jpg


Fig. 6.11
Various patterns of normal choroid plexus. (a) Posterior coronal scan shows double patterns of choroid plexus in both lateral ventricles. (b) Parasagittal scan shows a nodular density (arrow) of the glomus


6.3.1.4 Germinal Matrix Hemorrhage




A308051_1_En_6_Fig12_HTML.jpg


Fig. 6.12
Germinal matrix hemorrhage (GMH), Grade 1 in a 3-day-old female premature infant with 28 weeks gestational age. (a and b) Coronal (a) and right parasagittal (b) scans show ovoid-shaped-echogenic lesions in both caudothalamic grooves (arrows). (c) Follow-up coronal scan, 3 weeks later, shows cystic changes in both caudothalamic grooves


A308051_1_En_6_Fig13_HTML.jpg


Fig. 6.13
GMH/IVH, Grade 2 in a 2-day-old female premature infant at 29 weeks gestational age. (a and b) Coronal (a) and left parasagittal (b) scans show echogenic materials in left caudothalamic groove extending into left lateral ventricle and no ventricular dilatation


A308051_1_En_6_Fig14_HTML.jpg


Fig. 6.14
GMH/IVH, Grade 3 in a 7-day-old female premature infant at 28 weeks gestational age. (a) Coronal scan shows large echogenic materials in right caudothalamic groove and temporal horn of right lateral ventricle (arrows) with dilatation of both lateral ventricles. (b) Right parasagittal scan shows echogenic materials in right caudothalamic groove extending into right lateral ventricle forming a cast of ventricular configuration. (c) Right parasagittal scan, 4 weeks later, shows progressive dilatation of right lateral ventricle, heterogeneous echogenic materials in right lateral ventricle suggesting residual blood clots, and increased ependymal lining echoes (arrow) along ventricular walls due to secondary ventriculitis


A308051_1_En_6_Fig15_HTML.jpg


Fig. 6.15
GMH/IVH, Grade 4 in 1-day-old premature infant at 29 weeks gestational age. (a) Coronal scan shows echogenic materials in right caudothalamic groove extending into right frontal white matter and in left caudothalamic groove and both temporal horns of lateral ventricles with increased ependymal lining echoes (arrow). (b) Right parasagittal scan shows echogenic lesions in right frontal white matter as parenchymal hemorrhage (arrow) and in right lateral ventricle. (c) Coronal scan, 2 weeks later, shows cystic changes of right germinal matrix and parenchymal hemorrhage (arrow) and hydrocephalus


6.3.1.5 Intracranial Hemorrhage Except for GMH




A308051_1_En_6_Fig16_HTML.jpg


Fig. 6.16
Intracerebral hemorrhage in a 4-day-old female infant at 39 weeks gestational age. Coronal scan shows a round, discrete echogenic mass in right temporal lobe


A308051_1_En_6_Fig17_HTML.jpg


Fig. 6.17
Intraventricular hemorrhage in a 6-day-old infant with 36 weeks gestational age. (a) Posterior coronal scan shows heterogeneous echogenic lesions in both lateral ventricles with ventriculomegaly and increased ependymal echoes that cannot differentiate from normal choroid plexus. (b) Right parasagittal scan shows echogenic materials in posterior part of right lateral ventricle extending into the occipital horn representing as intraventricular hematoma


A308051_1_En_6_Fig18_HTML.jpg


Fig. 6.18
Subdural hemorrhage and cerebral infarction in a neonate with hemophilia. (a) Coronal scan shows a crescent echogenic lesion along left cranial convexity (arrow) with increased echogenicities of the underlying parenchyma and ipsilateral mass effect. (b) Axial scan through right mastoid fontanels also shows a crescent, echogenic lesion along left cranial convexity (arrow)


A308051_1_En_6_Fig19_HTML.jpg


Fig. 6.19
Intraventricular and secondary subarachnoid hemorrhages in a 10-day-old premature male infant. (a) Coronal scan through the anterior fontanelle show various echogenic materials in the lateral, third and fourth ventricles, and posterior fossa with intraventricular obstructive hydrocephalus. (b) Axial scan through the left temporal fontanelle demonstrates large extent of echogenic materials in the lateral and fourth ventricles (arrow) as IVH and in posterior fossa as secondary subarachnoid hemorrhage flowing out from IVH. (c) Midsagittal scan through the posterior fontanelle shows heterogeneous echogenic lesions in the third and fourth ventricles, cisterna magna, and superior cerebellar cisterns (arrows) as the combined pattern of intraventricular and secondary subarachnoid hemorrhages


A308051_1_En_6_Fig20_HTML.jpg


Fig. 6.20
Epidural hemorrhage in 1-day-old male term neonate with vacuum-induced vaginal delivery. Axial scan through the left mastoid fontanelle shows a lentiform, hypoechoic lesion along right parietal convexity with some echogenic debris and ipsilateral mass effect


6.3.1.6 Hypoxic-Ischemic Encephalopathy




A308051_1_En_6_Fig21_HTML.jpg


Fig. 6.21
Periventricular leukomalacia in a 3-day-old male premature neonate with 28 weeks gestational age. (a) Coronal scan shows discrete, extensive, and homogeneous echogenicities (arrows) in both periventricular white matters as well as the echogenicities of the corresponding choroid plexus. (b) Right parasagittal scan shows also discrete echogenicities in right peritrigonal white matter. (c and d) Follow-up coronal (c) and parasagittal (d) scans on 38 days later show multiseptate cystic lesions (arrows) in both periventricular white matters, especially peritrigonal areas that are confirmatory findings of periventricular leukomalacia

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Aug 20, 2016 | Posted by in PEDIATRIC IMAGING | Comments Off on Neurosonography

Full access? Get Clinical Tree

Get Clinical Tree app for offline access