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This is a screening head ultrasound in a seven week old

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female who was a former 30 week gestational age infant

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who had poor oral intake and lethargy.

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And so she came to screening head ultrasound in our nicu.

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So we're starting with that small footprint curved ray baby

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head transducer in the coronal plane going

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anterior to posterior.

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Um, we are looking at our ventricular size,

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nice symmetric ventricle caliber.

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There's no, uh, ventriculomegaly, no midline shift.

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Um, we have a normal, uh, small but normal cavem septum pum.

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This is our third ventricle

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and the first thing that's catching my eye is we see these

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abnormal genic,

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maybe a little bit heterogeneous foci at the right larger

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than left co alamic grooves.

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So this is the remnant anterior germinal matrix in this

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premature infant.

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Um, as we continue from going from anterior to posterior,

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uh, we don't have any abnormal hyper coic areas compared

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to our internal control choroid plexus.

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Our cerebellum does look a little bit genic,

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but I think that's just gonna be technique related.

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We'll confirm that on the sagittal view.

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Um, I don't see any blood filling the ventricles in this

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infant and our ventricle caliber,

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at least the lateral ventricles

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and third ventricles that we've seen

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so far are not enlarged.

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Um, so we're going off axis looking at the along the middle

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cranial fossa for any fluid collections

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or, uh, you know, epigenic foci in the brain parenchyma

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and everything looks normal.

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On our off axis plane imaging, we have a patent

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superior sagittal dur venous sinus.

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Um, on this view we see some

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of anterior cerebral artery coming around,

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but we definitely see some nice normal draining cortical

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veins and a normal patent superior sagittal dur venous sinus

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on the sagittal plane both anteriorly and posteriorly.

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Here comes our common carotid

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or rather internal carotid artery in our

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anterior cerebral artery.

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Nice normal color Doppler fill in

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of these normal vascular structures.

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But as we're coming off to the side, our caudate head,

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we're a little bit off plane here,

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but our caudate head will be here on the next slide.

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This is our thalamus. And

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so this is some abnormal academic material sitting right on

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top of the coth thalamic groove at the remnant anterior

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aspect of the germinal matrix.

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So this is gonna be a grade one germinal matrix hemorrhage

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on this right side in this infant.

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I don't see any other abnormal genic foci in

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that right lateral ventricle.

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Um, no other abnormalities that I see in that, uh,

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brain parenchyma as we go from midline to left.

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Um, again, uh,

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this is a symmetric abnormality in this infant.

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We have some abnormal echogenic, minimally heterogeneous,

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uh, material sitting right at the co

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fluent groove on this left side.

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So this is a left grade one germinal matrix hemorrhage in

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this infant on our trans mastoid imaging.

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Looking at, they're coming from the left mastoid, uh,

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fontanel, looking at the cerebellum,

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nice normal heart shaped cerebellum. Our

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Tentorium looks normal.

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Normal cerebellar verus, um,

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fourth ventricle is diminutive in this infant.

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It's not dilated or enlarged.

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It's hard to see that it's there.

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Um, as we switch to our linear high frequency transducer,

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to get a little bit more detail,

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you can see we have lost some of the peripheral detail,

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but we see these central structures of the brain beautifully

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and we see these abnormal genic foci at the right larger

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than left co limit groove.

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So bilateral grade one germinal matrix hemorrhages

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that we can see, um, with exquisite detail on these, uh,

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linear high frequency transducer images in both the coronal

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and sagittal planes.

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Um, on the cinematic images,

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it's gonna show us more of the same.

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I always look at these just as a sort of a checkpoint

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to make sure that the, um, sonographer didn't miss any areas

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of the brain parenchyma.

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Um, as we come to our sagittal, uh,

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this is the baby head transducer

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and the sonographer has thankfully labeled it from right

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to left, we see that grade one germ matrix hemorrhage.

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Our para ventricular white matter looks okay though,

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like nice normal, not bri,

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nothing is brighter than the choroid

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plexus on that right side.

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We are a little off access here

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because we don't, we don't see ly that, um, that, uh,

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a corpus closin, but that's okay.

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We still see this genic grade one germal matrix hemorrhage.

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Nice normal per ventricular white matter genicity on

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that left side as well.

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So, um, bilateral grade one germal matrix hemorrhages.

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But otherwise, normal head ultrasound.