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Showing posts with label USG Brain. Show all posts
Showing posts with label USG Brain. Show all posts

Case 107: Periventricular Leukomalacia Grade IV || Ultrasound

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Clinical Features:

1 month & 8 days old child was sent with the history of

- Prolonged labour.

- Perinatal asphyxia & hypoxic ischemic encephalopathy. 

- NICU support.

- Birth weight: ~ 3 kg.


Ultrasound Features:

- Areas of increased periventricular echogenicity.

- Extensive cystic lesions in fronto-parieto-temporo-occipital lobes extending into the deep white matter.


Remember:

Sonographic classification of PVL adapted from de Vries et. al.

Grade 1:  Increased periventricular echogenicity for ≥7 days; No cyst.
Grade 2:  Increased periventricular echogenicity; Small periventricular cysts.
Grade 3:  Increased periventricular echogenicity; Extensive periventricular cysts in the occipital and frontoparietal regions.
Grade 4:  Increased periventricular echogenicity & extensive cystic lesions extending into the deep white matter.


Ultrasound Diagnosis:

Periventricular Leukomalacia Grade IV 


Ultrasound Images:









Areas of increased periventricular echogenicity with extensive cystic lesions in fronto-parieto-temporo-occipital lobes extending into the deep white matter.


YouTube Link:

For further demonstration, don't forget to check our video:

YouTube Link






Case 45: Cerebral Atrophy - Pediatric Brain

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Clinical Features:

A 6-month-old child was brought with

- Inability to roll, crawl or sit

- H/o preterm delivery with low birth weight & hypoxic-ischemic encephalopathy


Ultrasound Features:

Prominent sulci & extraventricular CSF spaces with diffuse white matter volume loss, predominantly involving the frontal & parietal lobes.


Remember:

Regular follow-up scans of children with a history of HIE may help understand the progressive cerebral atrophy.


Ultrasound Images:



Fig: Sagittal sections. Prominent sulci. Normal corpus callosum


Fig: Coronal section. Prominent sulci, widened CSF spaces.


Fig: Sagittal section. Prominent sulci, widened CSF spaces.



YouTube Video Link:


https://youtu.be/shHF2ndqKK4



Case 41: Choroid Plexus Cysts || Neonate || Ultrasound

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Clinical Features:

A 7-day old neonate was sent for a routine cranial ultrasound scan.


Ultrasound Features:

- Multiple well-defined subcentimeter anechoic cystic structures with sharp margins are seen at the anterior end of the choroid plexus of the left lateral ventricle.

- Color Doppler shows no internal vascularity.


Remember:

Choroid plexus cyst usually gets resolved spontaneously. A follow-up scan is recommended.


Ultrasound Images:




Fig: Coronal & parasagittal sections; Tiny cysts in choroid plexus of the left lateral ventricle.


Fig: Parasagittal section; Tiny cysts in choroid plexus of the left lateral ventricle.


Fig: Parasagittal section; Tiny cysts in choroid plexus of the left lateral ventricle. Color Doppler shows no internal flow within these cystic lesions.


YouTube Video Link:



https://youtu.be/DrPfRo-FU7k








Neonatal Intracranial Hemorrhage

 

Neonatal Intracranial Hemorrhage


Grade-I Hemorrhage: 

  • One or more hyperechogenic areas just below the lateral ventricle, Best seen in a transverse plane adjacent to the frontal horn.
  • Confirm by doing a sagittal scan.
  • May be unilateral or bilateral.


Grade-II Hemorrhage:

  • Intraventricular bleeding (Additional echoes from the ventricles indicating thrombus or clot)
  • No ventricular dilatations.


Grade-III Hemorrhage:

  • Intraventricular Bleeding.
  • Dilated ventricles


Grade-IV Hemorrhage:

  • Intraventricular bleeding.
  • Bleeding into brain substance (increased echogenicity within the brain).





Case 32: Grade IV Intracranial Hemorrhage

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Grade-IV Intracranial Hemorrhage:


Clinical History

  • Preterm baby
  • Birth asphyxia
  • Low birth weight
  • Delayed crying/ No crying
  • Convulsion

Ultrasound Findings

  • Intraventricular bleeding.
  • Ventriculomegaly.
  • Brain parenchymal extension of hemorrhage

Prognosis/Sequelae

  • Poor prognosis
  • Posthemorrhgic hydrocephalus
  • Loss of brain tissue forming porencephalic cysts
  • Developmental retardation
  • Neurological deficits
 

Types of Intracranial Hemorrhage

  • Grade I: Isolated subependymal hemorrhage
  • Grade II: Intraventricular hemorrhage without ventriculomegaly
  • Grade III: Intraventricular hemorrhage with ventriculomegaly
  • Grade IV: Intraventricular hemorrhage with ventriculomegaly with parenchymal extension


Case 01:

  • 32 days old preterm low birth weight baby of an eclampsic mother with no history of crying since birth.
  • Ultrasound shows dilated lateral ventricles with clots around the choroid plexus. Intraparenchymal cystic lesion with internal clots are seen indicating intraparenchymal extension turing into porencephalic cysts.