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6 - The central nervous system

Published online by Cambridge University Press:  05 March 2012

Hiten Mehta
Affiliation:
University Hospitals Coventry and Warwickshire NHS Trust
Monica Epelman
Affiliation:
University of Pennsylvania
Claire Miller
Affiliation:
Birmingham Children's Hospital NHS Foundation Trust
Elaine M. Boyle
Affiliation:
University of Leicester Department of Health Sciences
Haresh Kirpalani
Affiliation:
Children's Hospital of Philadelphia
Monica Epelman
Affiliation:
Children's Hospital of Philadelphia
John Richard Mernagh
Affiliation:
McMaster University, Ontario
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Summary

Introduction

Neonatal imaging of the central nervous system has progressed rapidly in the last few years, although ultrasound (US) imaging remains the mainstay of bedside investigation. However, with the increased availability of magnetic resonance imaging (MRI), its potential utility is increasing. We highlight the relative usefulness of the imaging techniques available.

Principles of neuroimaging

Neuroinjury in the newborn

In the preterm a range of potential effects stem from the physiologically large and vascular structure of the germinal matrix of the preterm; and may include the superadded effects of hypoxemia or ischemia. These extend from bleeds, to obstructive lesions of the ventricles, to periventricular leukomalacia. Details of the neuroanatomical effects that are usually seen clinically are discussed below under “A standard approach to assessing normal anatomy on US examinations.” Figure 6.1A–D shows diagrams that depict the anatomical location of the germinal matrix and its potential for damaging changes. These are coupled with corresponding ultrasound images and can be compared with those in Figure 6.2. Figure 6.3A–D shows the relevant comparable MRI images. Figure 6.4A–C shows relevant US anatomy in axial scans obtained via a transmastoid approach. Finally, Figure 6.5A–D shows US Doppler images obtained for the evaluation of the superior sagittal sinus with a corresponding MR venography image.

Type
Chapter
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Publisher: Cambridge University Press
Print publication year: 2011

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References

1. W., Penfield, E., Boldrey. Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain 1937; 60:389–443.Google Scholar
2. American College of Radiology (2009) ACR–AIUM–SPR–SRU Practice Guideline for the Performance of Neurosonography in Neonates and Infants. Available at: www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/us/us_neurosonography.aspx (accessed March 15, 2011).
3. E. F., Maalouf, P. J., Duggan, S. J., Counsell, et al. Comparison of findings on cranial ultrasound and magnetic resonance imaging in preterm infants. Pediatrics 2001; 107(4):719–27.Google Scholar
4. M. K., Edwards, D. L., Brown, J., Muller, C. B., Grossman, G. T., Chua. Cribside neurosonography: real-time sonography for intracranial investigation of the neonate. AJR Am J Roentgenol 1981; 136(2):271–5.Google Scholar
5. K. J., Rademaker, C. S., Uiterwaal, F. J., Beek, et al. Neonatal cranial ultrasound versus MRI and neurodevelopmental outcome at school age in children born preterm. Arch Dis Child Fetal Neonatal Ed 2005; 90(6):F489–93.Google Scholar
6. M. I., Levene. Measurement of the growth of the lateral ventricles in preterm infants with real-time ultrasound. Arch Dis Child 1981; 56(12):900–4.Google Scholar
7. G., Enriquez, F., Correa, J., Lucaya, et al. Potential pitfalls in cranial sonography. Pediatr Radiol 2003; 33(2):110–17.Google Scholar
8. M., Epelman, A., Daneman, C. J., Kellenberger, et al. Neonatal encephalopathy: a prospective comparison of head US and MRI. Pediatr Radiol 2010; 40(10):1640–50.Google Scholar
9. P., Govaert, P., Vanhaesebrouck, C., De Praeter, K., Moens, J., Leroy. Vacuum extraction, bone injury and neonatal subgaleal bleeding. Eur J Pediatr 1992; 151(7):532–5.Google Scholar
10. J. D., Winter, D. S., Lee, R. M., Hung, et al. Apparent diffusion coefficient pseudonormalization time in neonatal hypoxicischemic encephalopathy. Pediatr Neurol 2007; 37(4):255–62.Google Scholar
11. B., Schmidt, E. V., Asztalos, R. S., Roberts, et al. Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms. JAMA 2003; 289(9):1124–9.Google Scholar
12. L. J., Woodward, P. J., Anderson, N. C., Austin, K., Howard, T. E., Inder. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med 2006; 355(7):685–94.Google Scholar
13. J. P., Boardman, C., Craven, S., Valappil, et al. A common neonatal image phenotype predicts adverse neurodevelopmental outcome in children born preterm. Neuroimage 2010; 52(2):409–14.Google Scholar
14. J. J., Volpe. Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances. Lancet Neurol 2009; 8(1):110–24.Google Scholar
15. S. J., Counsell, S. L., Tranter, M. A., Rutherford. Magnetic resonance imaging of brain injury in the high-risk term infant. Semin Perinatol 2010; 34(1):67–78.Google Scholar
16. M., Rutherford, L. A., Ramenghi, A. D., Edwards, et al. Assessment of brain tissue injury after moderate hypothermia in neonates with hypoxic-ischaemic encephalopathy: a nested substudy of a randomised controlled trial. Lancet Neurol 2010; 9(1):39–45.Google Scholar
17. P. L., Khong, C., Tse, I. Y., Wong, et al. Diffusion-weighted imaging and proton magnetic resonance spectroscopy in perinatal hypoxic-ischemic encephalopathy: association with neuromotor outcome at 18 months of age. J Child Neurol 2004; 19(11):872–81.Google Scholar
18. D., Azzopardi, A. D., Edwards. Magnetic resonance biomarkers of neuroprotective effects in infants with hypoxic ischemic encephalopathy. Semin Fetal Neonatal Med 2010; 15(5):261–9.Google Scholar
19. R., Berger, Y., Garnier. Perinatal brain injury. J Perinat Med 2000; 28(4):261–85.Google Scholar
20. J. M., Perlman. Intrapartum asphyxia and cerebral palsy: is there a link? Clin Perinatol 2006; 33(2):335–53.Google Scholar
21. J. J., Volpe (2001) Neurology of the Newborn, 4th Edition, Philadelphia, W. B. Saunders.Google Scholar
22. A. J., Barkovich (2005) Paediatric Neuroimaging, 4th Edition, Philadelphia, Lippincot, Williams and Wilkins.Google Scholar
23. A. J., Barkovich. MR imaging of the neonatal brain. Neuroimaging Clin N Am 2006; 16(1):117–35, viii–ix.Google Scholar
24. E. R., Heinz, J. M., Provenzale. Imaging findings in neonatal hypoxia: a practical review. AJR Am J Roentgenol 2009; 192(1):41–7.Google Scholar
25. M. A., Rutherford (2002) MRI of the Neonatal Brain, Philadelphia, W. B. Saunders.Google Scholar
26. I., Blumenthal. Periventricular leucomalacia: a review. Eur J Pediatr 2004; 163(8):435–42.Google Scholar
27. J. J., Volpe. Neonatal periventricular hemorrhage: past, present, and future. J Pediatr 1978; 92(4):693–6.Google Scholar
28. L. A., Papile, J., Burstein, R., Burstein, H., Koffler. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92(4):529–34.Google Scholar
29. A., Leviton, K., Kuban, N., Paneth. Intraventricular haemorrhage grading scheme: time to abandon? Acta Paediatr 2007; 96(9):1254–6.Google Scholar
30. A., Whitelaw. A different view: there is value in grading intraventricular hemorrhage. Acta Paediatr 2007; 96(9):1257–8.Google Scholar
31. B. S., Brann 4th, C., Qualls, L., Wells, L., Papile. Asymmetric growth of the lateral cerebral ventricle in infants with posthemorrhagic ventricular dilation. J Pediatr 1991; 118(1):108–12.Google Scholar
32. A., Brouwer, F., Groenendaal, I. L., van Haastert, et al. Neurodevelopmental outcome of preterm infants with severe intraventricular hemorrhage and therapy for post-hemorrhagic ventricular dilatation. J Pediatr 2008; 152(5):648–54.Google Scholar
33. N. J., Robertson, J. S., Wyatt. The magnetic resonance revolution in brain imaging: impact on neonatal intensive care. Arch Dis Child Fetal Neonatal Ed 2004; 89(3):F193–7.Google Scholar
34. L. L., Baker, D. K., Stevenson, D. R., Enzmann. End-stage periventricular leukomalacia: MR evaluation. Radiology 1988; 168(3):809–15.
35. A. J., Barkovich (2000) Paediatric Neuroimaging, 3rd Edition, St. Louis, Lippincott Williams and Wilkins.Google Scholar
36. H. B., Sarnat, M. S., Sarnat. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976; 33(10):696–705.Google Scholar
37. S., Takashima, D. L., Armstrong, L. E., Becker. Subcortical leukomalacia. Relationship to development of the cerebral sulcus and its vascular supply. Arch Neurol 1978; 35(7):470–2.Google Scholar
38. F., Villani, L., D'Incerti, T., Granata, et al. Epileptic and imaging findings in perinatal hypoxic-ischemic encephalopathy with ulegyria. Epilepsy Res 2003; 55(3):235–43.Google Scholar
39. J. K., Lynch. Epidemiology and classification of perinatal stroke. Semin Fetal Neonatal Med 2009; 14(5):245–9.Google Scholar
40. F., Cowan, E., Mercuri, F., Groenendaal, et al. Does cranial ultrasound imaging identify arterial cerebral infarction in term neonates? Arch Dis Child Fetal Neonatal Ed 2005; 90(3):F252–6.Google Scholar
41. I., Mader, M., Schöning, U., Klose, W., Küker. Neonatal cerebral infarction diagnosed by diffusion-weighted MRI: pseudonormalization occurs early. Stroke 2002; 33(4):1142–5.Google Scholar
42. T., Hayashi, T., Hashimoto, S., Fukuda, Y., Ohshima, K., Moritaka. Neonatal subdural hematoma secondary to birth injury. Clinical analysis of 48 survivors. Childs Nerv Syst 1987; 3(1):23–9.Google Scholar
43. J. C., Odita, S., Hebi. CT and MRI characteristics of intracranial hemorrhage complicating breech and vacuum delivery. Pediatr Radiol 1996; 26(11):782–5.Google Scholar
44. W., Squier, J., Mack. The neuropathology of infant subdural haemorrhage. Forensic Sci Int 2009; 187(1–3):6–13.Google Scholar
45. B. R., Foerster, M., Petrou, D., Lin, et al. Neuroimaging evaluation of non-accidental head trauma with correlation to clinical outcomes: a review of 57 cases. J Pediatr 2009; 154(4):573–7.Google Scholar
46. P., Lasjaunias, K., Ter Brugge, L., Lopez Ibor, et al. The role of dural anomalies in vein of Galen aneurysms: report of six cases and review of the literature. AJNR Am J Neuroradiol 1987; 8(2):185–92.Google Scholar

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