Journal of Medical Sciences and Health (Jun 2016)
Transcranial Perinatal Neurosonogram for Intracranial Pathology: Study of 165 Cases
Abstract
Background: The presence of open fontanelle in infants plays a major role in the ability to image the brain with ultrasound. The premature infants are more prone for hypoxic-ischemic insults and complications, which on early diagnosis helps the neonatal brain to protect from further insults. Aims and Objectives: Evaluation of intracranial pathologies by transcranial neurosonography in neonates and infants, by dividing into three groups: Preterms before 34 weeks, after 34 weeks, and unrelated to gestational age. All preterms and neonates are scanned early to diagnose intracerebral hemorrhages, hypoxic-ischemic encephalopathy (HIE), infections, and congenital problems and later follow-up scans to identify its complications for the timely management of neonate. Materials and Methods: A total of 165 infants with clinical suspicion evaluated on neurosonogram for 2 years. The study was conducted in the Department of Radiology using multi-frequency convex probe, sector probe and small linear probe, and Doppler flow studies. The babies were screened in coronal, sagittal, parasagittal planes using anterior fontanelle, transtemporal as an acoustic windows, and additional views whenever necessary. Results: Positive sonographic findings identified in 120 patients. Some patients showed more than one sonographic findings. 75% of preterm babies presented with intraventricular hemorrhage and on follow-up scans showed communicating hydrocephalus in 75% and 16% porencephalic cysts. In HIE, 74% had cerebral edema followed by periventricular echo densities. 10 cases of periventricular leukomalacia with 2-3 mm cystic lesions resulting in cerebral palsy. All infections presented with echogenic sulci or meningeal thickening in 38%. Hydrocephalus being the common sequelae in 48%. In congenital anomalies, hydrocephalus predominates the study in 54% with other associated anomalies such as Dandy–Walker malformation. Conclusion: Neurosonography is a non-invasive, safe, cost effective and allows for the prediction of neurological development. It provides a clue to a wide range of pathology and spectrum of pathological imaging appearances encountered in neonates. It is an accurate and sensitive modality for early diagnosis and timely management.
