Neurosonographic abnormalities in neonates with hypoxic ischemic encephalopathy.

Pattern of neurosonographic (NSG) abnormalities in 150 term newborn infants with hypoxic ischemic encephalopathy (HIE) was studied. Sonographic abnormalities, presumably indicating cerebral edema and or ischemia, were observed in 86% (n = 129) cases. Obliteration of the ventricles occurred as the sole abnormality in 30 (20%) cases. Eighty (53%) patients had diffusely increased echogenicity of the brain parenchyma (DPE) in addition to the compression of the ventricles, sulci and the interhemispheric fissure. Focal parenchymal echodense (FPE) lesions occurred in nine (6%) neonates with HIE. Ten (6.6%) patients, however, had increased periventricular echogenicity (PVE). Two patients, one with focal parenchymal lesions and the other with PVE had obliterated ventricles in addition. Regarding temporal sequence earliest NSG abnormalities were DPE or slit like ventricles that were observed on day-1 itself. Focal or periventricular echogenic lesions, however, made their first appearance on day-3 of life. Twenty one patients had normal scans. Fifty patients with abnormal scans died. None of the infants with normal scans, however, died (p < 0.001). At 4 weeks of age, scans performed in 100 survivors revealed no abnormality in 51 cases. Others showed development of cerebral atrophy (n = 21), multicystic encephalomalacia (n = 2), porencephalic cyst (n = 1), or persistence of PVE without cystic changes (n = 4). The results of this study highlight the diagnostic efficacy of neurosonography in cases of HIE. We suggest that it should be incorporated in the routine evaluation of patients with hypoxic brain injury.

Brain Computerized Tomographic Findings in Various Epilepic Children

Epilepsy is, in some occassions, manifested as one of the symptoms complex of central nervous system diseases, as well as systemic diseases such as metabolic disorders. In 1976, Bachman reported that 33% of epileptic patients manifested abnormal lesions in their computerized tomographic findings. 1005 epileptic children with various types of seizures have been investigated to detect the possible causes of epilepsies. 32% of the patients had abnormal brain C-T findings, of these patients, infantile spasm was the most frequently manifested abnormal C-T finding, rating 52.9%; simple partial seizure, 37.7%; complex partial seizure, 36.1% and generalized seizure, 27.1%, in order of frequency. Curable lesions, such as tumor, granuloma and arachnoid cyst were detected by brain C-T scan, and a brain tumor was detected in 2% of the patients. The brain C-T scan is one of the most effective diagnostic tools to evaluate the underlying lesions of the central nervous system of epileptic children.