By James D. Richardson, Edward G. Grant (auth.), Edward G. Grant (eds.)
Over an insignificant five years, neonatal cranial sonography has advanced from an imprecise and mostly experimental imaging threat to the modality of choice within the exam of the younger mind. the just about fast popularity of the ultrasound exam of the neonatal mind was once in keeping with a couple of coinci dent components, crucial of which used to be the emergence of a burgeoning inhabitants of untimely neonates who have been, for the 1st time, surviving be yond infancy. those gentle sufferers have been commencing to stand up to the trials of extrauterine lifestyles while now not totally ready for it; pulmonary, cardiac, and infec tious ailments not claimed so much of them. With survival, a brand new specter reared its head: might the eventual psychological and neurologic prestige of those comparable little ones be well worth the cost and time had to carry them via their first months? This factor turned more and more urgent as proof fastened in the course of the Seventies that very untimely neonates have been at a excessive chance for intracranial hemor rhage and posthemorrhagic issues. An imaging modality that may evaluation the untimely mind used to be sorely wanted. The CT scanner with its confirmed skill to diagnose intracranial hemorrhage was once of little price during this regard. So too have been static gray-scale or waterpath ultrasound devices. those modalities all had a similar obstacle, loss of portability. As neonatal extensive care devices proliferated, so did the know-how that will quickly permit cribside neonatal neuroimaging, the real-time area scanner.
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Extra resources for Neurosonography of the Pre-Term Neonate
Such subependymal cysts frequently appear almost in the midline on parasagittal sections. Note cerebellar vermis (e) in same section as subependymal cyst in E. 3. 60 The germinal matrix extends far posteriorly in very premature neonates; theoretically, therefore, GMH could originate in almost any portion of the ventricular floor. 10 Figure 31, however, clearly illustrates that these hemorrhages may vary, although the examples given do not correspond to the expected locations according to the gestational ages.
Most often the IVH is bilateral and fairly symmetric (Fig. 3-6, A and B). However, it may remain confined to one or the other ventricle. As illustrated in Fig. 3-6 A, the third ventricle may even be filled with blood. In this case, the ventricular cast may appear as a continuous echogenic Yshaped structure on coronal sections, since hematoma in the foramina of Monro render them visible. Even if the hemorrhage originates from only one germinal matrix, it often accesses the entire ventricular system before organizing.
The actual site of origin of IVH is considerably more academic than practical. After Pape and Wigglesworth,8 however, we shall assume that at least the majority of IVHs do originate in the germinal matrix. Regardless of its origin, or where it is found 42 in the body, fresh hematoma is always brightly echogenic. 72 Blood seems rapidly transformed from its original anechoic, liquid state to a highly reflective clot. This transformation probably occurs as soon as blood coagulates and fibrin strands, red blood cells (RBCs), and other components form interfaces.
Neurosonography of the Pre-Term Neonate by James D. Richardson, Edward G. Grant (auth.), Edward G. Grant (eds.)