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This was a seven week old.

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So one week of life, former premature infant

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who was born at 24

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and two weeks gestational age, who came

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for screening head ultrasound at Day of Life one.

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So as we start with our, uh,

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baby head transducer in the coronal plane going anterior

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to posterior the first image, we can see

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that there's gonna be an abnormality.

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Uh, we have dilated ventricles.

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We are a little bit off plane here, if that's okay.

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We have a dilated left frontal horn, lateral ventricle.

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The more striking abnormality is this very abnormal hyper

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coic material, completely filling this right lateral

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ventricle frontal horn.

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Um, there is associated abnormal hyper genicity

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of the adjacent per ventricular white matter.

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Um, and it is very challenging

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to see our ventricular or penal lining.

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Here is, uh, a much better example

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where you see this genic hemorrhage filling

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and expanding this right frontal horn lateral ventricle.

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We see abnormal hyper coic material in the adjacent

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periventricular white matter.

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We also see echogenic hemorrhagic material extending into

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the third ventricle here on this coronal plane.

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So this is gonna be formally known

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as grade four germinal matrix hemorrhage.

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Now it's more appropriately called periventricular

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hemorrhagic venous infarction, so formerly known

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as grade four germinal matrix hemorrhage.

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Um, on this left side, it's gonna be important for us to try

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to decide is there blood in this, um, left lateral ventricle

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or is it, um, being squished

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and entrapped by mass effect from

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that dilated right-sided ventricle.

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So, we'll, we'll play close attention to that

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as we go through these images.

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Our sonographer has measured

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where she thinks the frontal horn,

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right lateral ventricle ends,

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and also on the left, she's me measured the anterior

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horn, um, width.

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Um, on the sagittal plane, we're gonna see similar findings.

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And on this left side that this sonographer has labeled,

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we do see some abnormal academic material in

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this lateral ventricle.

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So this is gonna be a left grade three germinal matrix

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hemorrhage because we have genic blood in that ventricle

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and we have ventricular magaly at the time of presentation.

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Um, as we go to the right side to get a better look

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or a different look, different plane of

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that abnormal intraventricular hemorrhage

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and abnormal parenchymal hemorrhage.

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Um, we see similar findings as the coronal plane.

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Unfortunately in this infant, this is an example

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of the posterior fontella imaging.

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So this stenographer took her transducer

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and looked at the posterior fontella in this infant to try

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to get a little bit of a better visualization

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of structures posterior to the lateral ventricles.

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Not gonna lie, it didn't add much,

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but I thank you very much.

2:39

Sonographer. Wait.

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There's an important finding

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that I'm seeing on this trans mastoid view.

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Looking at this cerebellum.

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So this is labeled right side,

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so this is gonna be right cerebellar hemisphere.

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The more dependent side is gonna be the

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left cerebellar hemisphere.

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There is abnormal hyper coic material in

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this right cerebellar

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Hemisphere. So within

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the parenchyma of the cerebellum itself,

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the sonographer switched to the,

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the hockey stick transducer,

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which is a very high frequency linear transducer to try

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to get a better, better look at

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that right cerebellar hemisphere.

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And this is very concerning for hemorrhage in

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that right cerebellar hemisphere.

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So posterior fossa hemorrhage is especially bad, more

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so than super tentorial hemorrhage

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because the posterior fossa is a small space.

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And so when you have hemorrhage in your posterior fossa,

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it can cause um, problems related

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to mass effects on such a small confined space, more

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so than super tentorial hemorrhage.

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So of course, it's not good

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to have periventricular hemorrhagic venous infarction.

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It's also not good to have grade three germinal matrix

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hemorrhage, but there's increased morbidity in mortality

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when you have posterior fossa hemorrhage.

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So let's confirm that on our cinematic images.

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So we'll start with our linear high frequency transducer

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images going from anterior to posterior.

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The linear high frequency does not

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give us super great detail.

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So let's go to our, um, baby head transducer

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to see if we can see some be, see better detail.

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So on our curve, small footprint transducer, uh,

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the tech clearly had, had difficulty scanning this patient.

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Uh, you can see this dilated left vental horn,

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lateral ventricle academic hemorrhage filled right lateral

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ventricle with per ventricular hemorrhagic venous infarction

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as we're going anterior to posterior.

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And I did not notice this, uh,

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cerebellar hemisphere my first go round through this, uh,

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Corona plane series.

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But you can see

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that abnormal right cerebellar hemisphere hemorrhage.

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Let's go to a, um, sagittal to see if we can see that, uh,

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those structures better.

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Here. We're going midline to the right again,

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that abnormal hemorrhage within the ventricle dilated

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ventricle with per ventricular hemorrhagic venous infarction

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with that abnormal hyper coic cerebellum

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with architectural distortion of structures.

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Let's go to our, we have a syne of this, uh,

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through the right mastoid fontanel, so we can see

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that, uh, cerebellar abnormalities even better.

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Unfortunately. So the fourth ventricle is completely a face.

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There is a mass effect

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of the right cerebellum towards the left.

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So unfortunately this infant does have a,

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an even poorer prognosis

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because of the presence

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of this right cerebellar hemisphere hemorrhage.

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So we have poster fossa hemorrhage, right

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per ventricular hemorrhagic venous infarction

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and left GRE three germal matrix hemorrhage in this

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unfortunate infant.