Diagnostic ultrasound ( PDFDrive )

1556 PART V Pediatric Sonography
A
B
C
FIG. 45.53 Focal Infarction in Term Infant. (A)
Coronal sonogram shows early focal echogenicity in the
left temporoparietal region in area of middle cerebral artery
vascular distribution. (B) Computed tomography scan
several days later shows evolving infarction, seen as large
areas of hypodensity on both sides of the brain—a typical
parasagittal distribution. (C) Coronal pathology specimen
in a different patient shows a typical focal infarction
extending to the brain surface in a parasagittal distribution.
(With permission from Friede R. Developmental neuropathology.
2nd ed. New York: Springer-Verlag; 1975. 42 )
Cerebral Infarction: Sonographic Signs
Echogenic parenchyma
Lack of low on color Doppler and pulsed Doppler
Mass effect from edema
Arterial territorial distribution of injury
Decreased sulcal deinition
Increased pulsation in periphery of infarcted section
Early collateral arterial vessels within hours of insult
ipsilateral ventricular enlargement from evolving atrophy
(hydrocephalus ex vacuo), as well as a gradual return of arterial
pulsations in the major branches from proximal to peripheral
distribution. Cerebellar lesions are typically peripheral and thus
do not lead to local ventricular enlargement. Using color Doppler
imaging, luxury perfusion has been identiied within hours of
a focal vascular insult, both experimentally and in newborn
infants. Power Doppler may be more sensitive than color Doppler
in detecting the increase in the size and number of vessels seen
with luxury perfusion.
Lenticulostriate Vasculopathy
Linear branching echogenicity in the lenticulostriate arteries of
the thalamus and basal ganglia is uncommon but has been
described in intrauterine viral infections (CMV, rubella, syphilis)
(Video 45.17 and Video 45.18), neonatal asphyxia, nonimmune
hydrops, fetal alcohol syndrome, and trisomies 13 and 21. Coley
and colleagues 186 reported that hypoxic-ischemic conditions
accounted for 30 of 63 cases. In a study by Amir, of 92 infants