0:01

So this was a one week old,

0:02

former 30 week gestational age premature inference who came

0:05

for screening head ultrasound at one week of life.

0:08

So we start with our baby head transducer in the coronal

0:11

plane going anterior to posterior,

0:13

and right away we see dilated lateral ventricles.

0:16

So rather than that sort of pointy appearance

0:18

of the frontal horn lateral ventricle,

0:20

these are a little bit rounded.

0:23

The next thing we see is, uh,

0:24

there's some subtle academic material on that left side.

0:28

A little bit more obvious on that right side.

0:31

Um, so genic material in the absence of clinical concern

0:34

for infection of ventriculitis type picture

0:37

in a premature infant,

0:39

this is gonna be germal matrix hemorrhage.

0:41

So on both sides, on this left side it's a little bit lower,

0:45

uh, hyper coic material genicity.

0:47

And on the right it's much more genic, um, hyper genicity,

0:52

hyper coic material within that ventricle.

0:55

And we have ventricular enlargement.

0:57

And so right away we know this is gonna be at least a grade

1:00

three germinal matrix hemorrhage.

1:02

As we continue posterior, uh, we see the choroid plexus,

1:05

but there's also this genic material, uh, surrounding

1:09

and sitting on top of the choroid plexus bilaterally.

1:12

Our sonographer put measurements on the, on the ventricles,

1:16

depending what your neonatologists

1:19

and if you have neurosurgeons at your institution, uh,

1:22

depending what they want,

1:23

you might make different measurements.

1:25

There's lots of different ways to measure the ventricles,

1:27

and this is just the frontal horn width

1:29

that the sonographer has measured here at our institution.

1:32

Um, our current protocol,

1:34

we actually measure the ventricular index as well.

1:37

So just touch base with your neonatologist

1:39

or neurosurgeons to decide how, how they want you

1:42

to measure, uh, and report ventricle size.

1:45

But, uh, at any rate, these are mildly enlarged, um,

1:49

lateral ventricle, frontal horns and occipital horns.

1:52

As we go to the sagittal plane, we're coming off

1:55

to the right side here.

1:56

We can see that again, that echogenic material in

1:58

that lateral ventricle that is dilated coming off

2:01

to the left side that remember blood runs downhill

2:04

and most babies aren't getting tummy time in the nicu.

2:08

Most premature infants are at a minimum on some sort

2:10

of positive pressure ventilation

2:12

or they're intubated in the ICU

2:14

and so they are gonna be in the supine position.

2:17

So blood is gonna roll dependently in the lateral ventricle.

2:20

So always make sure you're looking along the, um, atria

2:25

and posterior most aspect of the lateral ventricles

2:28

to look for hemorrhage.

2:29

Um, but we could see it on the frontal view

2:31

and the frontal horn, lateral ventricles

2:32

as well in this infant.

2:34

Um, this is a premature infant

2:36

because as we are looking at our cinematic images

2:40

as we go from anterior to posterior,

2:42

we do have some cingulate sulcus formation.

2:45

Um, also our clinicians have told us this

2:48

patient's gestational age.

2:50

So, um, uh, we know that this is a premature infant.

2:53

So unfortunately bilateral grade three germinal matrix

2:56

hemorrhage, we do see also a little bit

2:58

Of, of hemorrhage that has extended into this, uh,

3:01

third ventricle here in this infant

3:04

with bilateral grade three germinal matrix hemorrhage.

3:08

So after this infant screening had ultrasound, um,

3:11

the patient came to MRI

3:13

to further delineate the abnormalities.

3:15

So we'll start on this sagittal T one weighted, uh, MRI

3:19

where you can see there's this abnormal T one hyperintense

3:22

blood layering dependently in the

3:24

dilated lateral ventricles.

3:26

Uh, this one is not so much dependent,

3:28

but we don't see any other abnormal T one hyperintense foci

3:32

in the brain parenchyma of this infant.

3:34

The ventricular mele, you're gonna be able

3:36

to see a little bit better on these axial images.

3:38

So we have dilated lateral ventricles.

3:41

Third ventricle is at the upper limit of normal.

3:43

Fourth ventricle is normal in caliber,

3:45

but we can see this T two, uh,

3:48

low signal hemorrhage layering dependently in these, uh,

3:51

dilated lateral ventricles.

3:53

Um, similar findings are seen on this T one weighted axial

3:57

sequence where the hemorrhage is hyperintense in signal.

4:01

And then I think the susceptibility weighted images are

4:03

where you can see hemorrhage much, much better.

4:05

You get that susceptibility related to the hemosiderin.

4:07

So lots of low signal susceptibility related to this,

4:12

this hemorrhage bilaterally in this

4:14

infant's dilated ventricles.

4:15

So bilateral grade three germinal matrix hemorrhages

4:19

confirmed at MRI.