Background-Screening cranial ultrasound led to the discovery of isolated frontal horn cysts quite distinct from periventricular leucomalacia cysts. Aim-To clarify their significance, incidence, characteristics, causal factors or aetiology, and eVect on long term outcome. Design-A retrospective observational study of all first cranial ultrasound scans (total of 2914) performed during the period 1984-1994 inclusive found 21 neonates with smooth thin walled frontal horn cysts: 18 of 2629 scanned were of birth weight < 1500 g or gestation < 33 weeks, and three of 285 were > 33 weeks gestation. Sequential ultrasound, maternal records, and neonatal events were retrospectively assessed. In survivors, routine neurodevelopmental evaluations were obtained. Postmortem studies of one cyst were performed to determine the nature and origin of these lesions. Results-Of the 21 subjects, 15 had isolated frontal horn cysts and six had additional ultrasound scan abnormalities, including four with subependymal haemorrhage. The sonographic features of frontal horn cysts were of distinctive morphology (elliptical, smooth, thin walled, ranging in size from 3 to 20 mm) and position (adjacent to the tip of the anterior horns). The cysts enlarged and then regressed by a median corrected age of 2 months. Subjects of < 33 weeks gestation (n = 18) had a median birth weight of 1465 g (range 720-1990) and median gestation of 30 weeks (range 24-32).
SUMMARY Sixty seven of 216 infants weighing less than 2 kg at birth had cerebral lesions on ultrasonic scanning. Eight of 17 who had periventricular leukomalacia, with or without subependymal or intraventricular haemorrhage, or both, died. These and one larger baby were the subject of a combined ultrasound, and where appropriate, necropsy study. There was excellent correlation between the ultrasound and necropsy findings, only some of the earlier lesions of periventricular leukomalacia being missed by ultrasound. The data suggest it is now possible to distinguish periventricular leukomalacia and subependymal/intraventricular haemorrhage by ultrasound, that both lesions may be present in the same brain, that apparent parenchymal extension of an intraventricular haemorrhage is more probably the result of haemorrhage into ischaemic periventricular tissue, and that the term 'periventricular haemorrhage' should be abandoned since it confuses two lesions of differing aetiology and differing clinical importance. Future advances in neonatal brain ultrasound depend on accurate assessment of both the nature and site of lesions within the cerebral hemispheres and ventricular system since the interpretation of these parameters is of critical importance.The periventricular regions of the brain of the preterm neonate are known to be particularly susceptible to circulatory disturbances. Two major groups of lesions are recognised, the subependymal haemorrhage (or germinal matrix haemorrhage) /intraventricular haemorrhage complex, simplistically related to hyperperfusion of the brain, and periventricular leukoencephalomalacia related to hypoperfusion.l There is growing evidence from follow up studies that the prognosis of the former disorder is good whereas it is frequently very poor with periventricular leukomalacia.2The advent of techniques to show lesions of the neonatal brain during life has greatly extended knowledge about the genesis and natural history of these disorders but their exact inter-relation remains controversial.3 The relatively low resolution of early scanning instruments combined with ignorance of the natural history of the lesions prevented distinction between subependymal/intraventricular haemorrhage and periventricular leukomalacia, the term periventricular haemorrhage being introduced to describe all echo dense lesions related to the walls of the lateral ventricles. Subsequent discussion of periventricular haemorrhage as a single entity has obscured the differences and associations between the lesions. In 1983 we described the ultrasound appearance of early periventricular leukomalacia before the cystic phase had developed.4 Other authors have confirmed our observations, though some stress the haemorrhagic nature of these lesions.i7 Improved techniques now allow the distinction between these two groups of lesions, yet there are few combined ultrasonic and necropsy studies of either subependymal/intraventricular haemorrhage8 or periventricular leukomalacia.9The present study endeavours to distinguish betwe...
A previously unrecognised and distinctive pattern of severe brain injury in extreme preterm neonates was observed recently. Fifteen neonates of birth weight 600-1270 g and gestation of 24-32 weeks showed relatively late development on cerebral ultrasound scan of extensive dense and cystic lesions involving the periphery of the brain. The extent of the changes was confirmed at postmortem examination in 11 babies. These changes have been calied encephaloclastic porencephaly. The population of babies in whom this has occurred and their clinical outcome has been reviewed, with comparison between the evolution of the ultrasound changes and pathological findings at postmortem examination.
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