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ULTRASOUND Karen Rosendahl
När görs us:
<1500g/x antal veckor
* Systematisk bildtagning
* Högfrekvens transducer - använda samma maskin konsekvent
* Använda temporal och occipitalat fönster lika väl som anteriora fontanellen
Checklista:
Bleed? Size?
Intraventricular?
Ventricular size(Davies Et al)
Infarction(mer högekogent än vanlig hjärna, mer jämnt avgränsat än blödning)? Size?
Additional findings?
4 stadier av germinal matrix blödning på ultraljud (från ped vasc anteckning):
Stadie I: Hyperekoisk blödning subependymalt främst i caput av nucleus caudatus ( tillsammans med en liten intraventrikulär blödning).
Stadie II: Hyperekoisk blödning i laterala ventriklar.
Stadie III: II+vidgat ventrikelsystem.
Stadie IV: III+ blödning i djup vit substans i centrum semiovale.
Normalvarianter:
* Bright thalamostriate vessels.
* Lobulated plexus can be normal (not bleed) (Plexusvävnad har flöde på doppler)
* Assymeteric ventricles can be normal
Thalamostriate vener kan komprimeras av GM blödning vilket leder till hinder av flöde från medulära vener -> Venös infarkt.
Skada i vit substans -> hyperekoiskt -> bildning av cystor
Andra fynd:
White matter injury
Cerebellar injury (försök titta på cerebellum från occ fontanell)
Cerebrala malformationer (en passant)
Övriga tips: Man kan komprimera fontanell för att skapa flöde i 4de ventrikel.
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Neonatal medicine in Prematurity: Janet Rennie
Preterm brain injury - causes:
* GMH- IMH - Few present with symptoms, often diagnosed on imaging,
ultrasound cannot detect <0,5cm
* Hemorrhagic venous infarctions.
* Different subtypes of venous infarctions -> different prognosis (dudink et al)
* PHVD -Post Haemoragic Ventricular Dilatation, 15% of these require shunt
Need monitoring of ventricular size and head size.
Diffuse White Matter Injury -
Important cause of damage in preterm babies - but NOT so tightly correlated to gestational age.
Development:
Preoligodendrocyte->Oligodendrocyte->Myelinated Oligodendrocyte
30-32 Weeks
Early stages sensitive to damage: Hypoxic,cytokine,reduced cerebral blood flow, hypocarbia
DEHSI - Diffuse exessive high signal intensity - Described by some in upto 70% of preterm
Tractography (may be usefull in detecting abnormalities)
(NEC linked to CP)
Hypocarbia, below 3,3 kPa - risk for PVL
Outcome should be measured including Behavior, cognitive and motor skills.
IQ normal in gestational age over 32, below that a linear relationship can be seen between gestational age and IQ.
ADHD may be linked to diffuse disease. Some may also be linked to parenchymal damage and hydrocefalus.
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Neonatal Neurorad in Prematurity - Barcovich
- Babies w. congenital heart disease have similar white matter punctate lesions compared to preterm babies