0:00

Okay, so preterm ultrasound, uh, has, you know,

0:03

different manifestations, right?

0:04

So you can have some of this kinda

0:07

what periventricular white matter injury.

0:09

You could have this grade three IVH with the coto thalamic,

0:12

you know, an interventricular hemorrhage and hydrocephalus.

0:14

And you see that echogenic kind of debris

0:16

along the ventricles.

0:18

So normal germinal matrix can also be genic,

0:20

but it's very well defined in curve.

0:21

And you're, you're not gonna get that extra

0:23

debris and distension.

0:25

And here's a grade four intraventricular hemorrhage, right?

0:27

So now you have so much, uh, clot, right?

0:29

Asymmetric here that it's actually plugged up the met veins.

0:32

And so you have this radiating per

0:34

ventricular hemorrhagic infarct.

0:35

So, um, the ultrasound echogenicity is tricky

0:39

'cause it can be like a little bit of white matter injury.

0:41

It can be some mineralization, it can be hemorrhage, right?

0:43

So be a little careful

0:44

because many things can look echogenic, right?

0:47

But it's really looking at these secondary signs as well.

0:49

And you see that all of these have like this kind

0:51

of an immature ation pattern, right?

0:53

Of the preterm infant as well. Okay?

0:56

So at um, at Mr right, uh,

0:59

preterm interventricular hemorrhage.

1:00

So this is that grade one kato thalamic groove grade

1:03

two in the ventral clinic.

1:04

You see, it's not just that layering,

1:05

but you see that on T two

1:07

or susceptibility, you see that kind

1:08

of like dark line, right?

1:10

That shows that you had hemorrhage,

1:11

even if it's completely resorbed,

1:12

you can still see that's cirrhosis.

1:14

Here's grade three with some distension and shunting.

1:18

And then here's that grade four

1:19

where you're clogging up the ventricles,

1:20

and now you have that per ventricular hemorrhagic, uh,

1:23

venous infarct, and then the late complications, right?

1:26

So this doesn't just stay like this, right?

1:28

Basically involutes

1:29

and, uh, the term porn cephas a white matter, you know,

1:32

relatively clean line cyst

1:34

because again, in neonates they have very immature,

1:37

uh, glymphatic system.

1:38

So the astrocytes are these glial cells that cause

1:41

astro gliosis, right?

1:42

So the scarring after injury.

1:45

And so those things are not mature

1:46

until the first couple years of life.

1:48

So when you get an injury like this as opposed to an adult,

1:50

it can be a very clean cavity.

1:51

And so that's porn cephalic.

1:53

So basically these things can, um, can involute,

1:56

you can have cirrhosis,

1:57

you can have trans mantle porn cephalic essentially, so

2:00

that you have almost no residual cortical mantle.

2:02

And then you can have the dreaded complication,

2:04

which you see in many preterm infants

2:06

of the post hemorrhagic hydrocephalus.

2:08

You get all these adhesions, he post hemorrhagic adhesions

2:11

and isolation of the ventricles.

2:13

And it becomes very difficult to manage their hydrocephalus

2:16

because you have so many different loculation in here,

2:20

the white matter injury, um, so early.

2:23

So again, like, uh, there's,

2:25

there's obviously intraventricular hemorrhage board here,

2:27

but you see these separate areas of like little hemorrhagic.

2:30

And these are not next to the ventricle.

2:32

They're not caused by clot, right?

2:33

So these are actually separate areas of white matter injury

2:36

with blood fluid levels with this T one shortening

2:39

of dys myelination, um, cystic, you know, and,

2:43

and so these little areas, right?

2:44

So in the watery brain it's gonna be baseline white matter,

2:48

uh, is is unmyelinated.

2:50

So it's gonna be T one dark T two bright, right emus brain.

2:55

And so on that background you can see little areas

2:57

of white matter injury or dys myelination

2:59

With this kind of ceto toxic insult, right?

3:01

Mineralization with this T one bright T two dark signal.

3:06

And the T two stuff is kind of more variable

3:09

'cause um, you already, it's kind of already watery,

3:11

so it can be a little hard to tell,

3:12

but the T one can actually be very, very helpful.

3:16

Um, and then late findings.

3:17

So if you just see this kind of like patchy, you know, uh,

3:20

periventricular white matter stuff

3:22

and there's volume loss, right?

3:24

You suspect, right? Even if this is an adult, right?

3:26

And you're reading it that you suspect that they had some,

3:28

uh, preterm, uh, white matter injury.

3:31

Uh, when it's more profound,

3:32

they actually have this angular morphology.

3:33

It's the draining medullary veins.

3:36

So they kinda have this, uh, triangular shape to them

3:39

of the watershed, and then angular exo

3:42

dilation of the ventricles.

3:43

And here's the cystic per ventricular lomaia.

3:45

So actually cavitating now,

3:47

but again, that kind of para ventricular watershed.

3:49

And then here's one with like porn cephalic and adhesions,

3:51

and very, very thin cortical mantle.

3:53

A lot of, uh, white matter predominant volume loss.

3:58

All right? And then we have cerebellar hemorrhage.

4:00

So, uh, again, this can be on T two or susceptibility,

4:03

but you see these areas of, you know, dark signal

4:06

and you can have like a few foci, uh, or several

4:09

or even like diffuse threat, the cerebellum leading to,

4:12

you know, hemorrhagic infarct and hypoplasia and so forth.

4:16

Uh, so in the long term, so this is a ultrasound here,

4:18

you can actually see this, uh,

4:19

dinky little dinky little cerebellum.

4:21

And same thing on Mr. Here, right?

4:23

So they can be very, um, hypoplastic, uh,

4:26

because it's basically an

4:28

acquired insult as they're developing.

4:29

You can even have, uh, hypoplasia dysplasia

4:32

and cerebellar class, right?

4:33

So these were basically areas of injury, um, of hemorrhage.

4:36

And then the, the cerebellum,

4:38

which actually develops quite a bit postnatally in the first

4:41

like two or three years of life will,

4:43

will foliate abnormally around these areas

4:45

of acquired injury.