Posterior fossa intracranial hemorrhage in infants treated with extracorporeal membrane oxygenation: sonographic findings.

Bulas, Dorothy; Taylor, George A.; Fitz, Charles R.; Revenis, Mary; Glass, Penny; Ingram, James D.

doi:10.2214/ajr.156.3.1899761

Cited by 68 publications

(74 citation statements)

References 20 publications

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“…Posterior fossa hemorrhages associated with traumatic delivery are believed to be a result of severe distortion and disruption of the venous structures within the compliant neonatal skull, leading to laceration of the tentorium or falx or a traumatic cerebellar laceration along the vermis. 3,14,22 Cerebellar hemorrhage may relate to increases in venous pressure, as seen in infants on ECMO 7,8 or with face mask ventilation. 12,15 Cerebellar hemorrhage also may relate to impaired cerebral flow autoregulation 7,22 or coagulopathy.…”

Section: Discussionmentioning

confidence: 99%

“…3,14,22 Cerebellar hemorrhage may relate to increases in venous pressure, as seen in infants on ECMO 7,8 or with face mask ventilation. 12,15 Cerebellar hemorrhage also may relate to impaired cerebral flow autoregulation 7,22 or coagulopathy. 7,9 Donat and colleagues 11 postulated that cerebellar hemorrhage in preterm infants resulted from dissection of blood from either the fourth ventricle or the subarachnoid space, secondary to a concomitant severe intraventricular hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…12,15 Cerebellar hemorrhage also may relate to impaired cerebral flow autoregulation 7,22 or coagulopathy. 7,9 Donat and colleagues 11 postulated that cerebellar hemorrhage in preterm infants resulted from dissection of blood from either the fourth ventricle or the subarachnoid space, secondary to a concomitant severe intraventricular hemorrhage. Yet none of the 6 infants described in this report had intraventricular blood evident on ultrasonographic examination.…”

Section: Discussionmentioning

confidence: 99%

“…ECMO, extracorporeal membrane oxygenation, CT, computed tomography; MRI, magnetic resonance imaging; SEH, subependymal hemorrhage; MDI, Motor Development Index; PDI, Psychomotor Development Index. P osterior fossa hemorrhage is a reported complication of a traumatic delivery, [1][2][3][4][5][6] extracorporeal membrane oxygenation (ECMO), 7,8 or coagulopathy. 2,8,9 It also has been reported in preterm infants as an extension of a severe intraventricular hemorrhage 2,10 -14 or as a result of positive pressure mask ventilation with tight binding straps across the occiput.…”

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A New Pattern of Cerebellar Hemorrhages in Preterm Infants

et al. 1998

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ABSTRACT.Objective. Posterior fossa hemorrhages may be underdiagnosed in surviving neonates, with cerebellar hemorrhage discovered in 10% to 25% of autopsy specimens from very low birth weight infants. Posterior fossa lesions have been difficult to visualize by the traditional ultrasonography approach through the anterior fontanelle. Late in 1994, routine posterior fossa imaging through the posterolateral fontanelle was instituted to improve the ultrasonographic visualization of the posterior fossa in neonates.Methods. Infants identified with posterior fossa hemorrhage by cranial ultrasonography between 1994 and 1996 were followed prospectively through discharge and their clinical courses reviewed. Infants diagnosed with posterior fossa hemorrhage between 1991 and 1994 were identified retrospectively from a comprehensive radiology database to use in comparison. All infants surviving to discharge were entered into neurodevelopmental follow-up using standard developmental assessments.Results. Approximately 525 infants underwent cranial sonography during the study period between October 1994 and September 1996, including 250 infants weighing <1500 g. Thirteen infants were identified with posterior fossa hemorrhage using the posterolateral fontanellar approach. In contrast, only 2 infants were identified with posterior fossa hemorrhage between 1991 and 1994 using traditional anterior fontanellar views. Six very low birth weight infants were identified with cerebellar hemorrhages not associated with supratentorial, intraventricular hemorrhage. Each hemorrhage had a clinically silent presentation and, in 5 infants, was not wellappreciated by anterior fontanellar images. Magnetic resonance imaging studies were performed on 5 of the 6 infants and confirmed a cerebellar lesion in the area of previous echo density on ultrasonography. No infant is exhibiting motor abnormalities on neurologic examination, although 4 infants are demonstrating cognitive, developmental delay. Follow-up, however, is limited to a corrected age of <48 months.Discussion. Cerebellar hemorrhage is an underrecognized and poorly visualized complication in preterm infants. Consistent imaging via the posterolateral fontanelle may demonstrate cerebellar hemorrhage missed by the anterior fontanellar approach. Cerebellar hemorrhage in low birth weight infants may be clinically silent and not associated with a significant supratentorial hemorrhage. These infants may survive to discharge. Long-term neurodevelopmental follow-up is necessary to establish the ultimate outcome of these infants. Future prospective study, using posterolateral fontanellar imaging, may elucidate further the pathophysiology of cerebellar hemorrhage in low birth weight infants. Pediatrics 1998;102(6). URL: http://www.pediatrics.org/cgi/content/full/102/6/ e62; posterior fossa, cerebellar hemorrhage, neonate, ultrasound.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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A New Pattern of Cerebellar Hemorrhages in Preterm Infants

et al. 1998

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“…2 Infants undergoing ECMO are at high risk for brain injury and therefore should undergo serial cranial ultrasound imaging before, during, and after ECMO treatment. 3 While cranial ultrasound is a very useful imaging modality and generally a first choice for initial imaging, there are limitations. In cases where very detailed brain parenchymal anatomy is needed, MRI provides greater resolution.…”

Section: Indications For Neonatal Cranial Ultrasoundmentioning

confidence: 99%

Neonatal cranial ultrasound: current perspectives

Franco¹,

Lewis²

2013

RMI

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Ultrasound is the most common imaging tool used in the neonatal intensive care unit. It is portable, readily available, and can be used at bedside. It is the least expensive cross sectional imaging modality and the safest imaging device used in the pediatric population due to its lack of ionizing radiation. There are well established indications for cranial ultrasound in many neonatal patient groups including preterm infants and term infants with birth asphyxia, seizures, congenital infections, etc. Cranial ultrasound is performed with basic grayscale imaging, using a linear array or sector transducer via the anterior fontanel in the coronal and sagittal planes. Additional images can be obtained through the posterior fontanel in preterm newborns. The mastoid fontanel can be used for assessment of the posterior fossa. Doppler images may be obtained for screening of the vascular structures. The normal sonographic neonatal cranial anatomy and normal variants are discussed. The most common pathological findings in preterm newborns, such as germinal matrix-intraventricular hemorrhage and periventricular leukomalacia, are described as well as congenital abnormalities such as holoprosencephaly and agenesis of the corpus callosum. New advances in sonographic equipment enable highresolution and three-dimensional images, which facilitate obtaining very accurate measurements of various anatomic structures such as the ventricles, the corpus callosum, and the cerebellar vermis. Limited studies have been performed to predict that longitudinal measurements of these anatomic structures might predict the clinical outcome of high-risk preterm newborns. Hemodynamic Doppler studies may offer the potential for early intervention and treatment to counter the hazards of developmental delay and a moribund clinical outcome.

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