Sonographic changes in a parasagittal cerebral lesion in an asphyxiated newborn

Abstract

Parasagittal cerebral injury is one of the major neuropathologic varieties of neonatal hypoxic-ischemic encephalopathy.' The lesion involves the cerebral cortical and subcortical white matter with a characteristic location at the parasagittal, superomedial aspects of the cerebral convexity. One hemisphere may be more involved than the other, and the parietooccipital region is more frequently affected. The lesion has been diagnosed by pneumoencephalography, technetium brain scan, computed tomography, and recently positron emission t~mography.~-~ We report the serial sonographic findings of parasagittal cerebral injury in an asphyxiated newborn that was confirmed by CT scan. CASE REPORTThis patient was born at 38 weeks of gestation to a 27-year-old primipara who was a heavy smoker. The infant weighed 1,850 g at birth and had Apgar scores of 2 and 5 at 1 and 5 min, respectively. He was resuscitated and transferred to Mackay Memorial Hospital immediately. On examination the infant was lethargic, stained with meconium, and had a cephalhematoma over the right parietal area. Spontaneous movements appeared to be scanty but symmetric. He was hypotonic, and the deep tendon reflexes were weak and symmetric. He had transient focal seizures at the age of 2 days.Serial real-time cranial ultrasound examinations through the anterior fontanel using an Aloka sector scanner (SSD-720) with a 5.0-MHz transducer were then done. Scanning through a water bag on top of the anterior fontanel was also used to enhance superficial cortical imaging. The first scan at the age of 2 days showed increasing echoes

Reversal sign on CT: effect of anoxic/ischemic cerebral injury in children.

“…An anoxicfischemic insult may cause a variety of neuropathologic abnormalities, including neuronal necrosis, marmoration of basal ganglia and thalami, "watershed" infarcts, and periventricular leukomalacia [1][2][3]. Sonography and CT have been used as the primary imaging methods for evaluation of patients with acute anoxic/ ischemic insults [4][5][6][7][8][9][10][11][12][13]. There are scattered reports describing diffuse cerebral edema on CT [14][15][16][17] and/or sonography [18].…”