ABSTRACT
Infants with periventricular-intraventricular hemorrhage (PV-IVH) were followed up with weekly ultrasound sector scans to define the natural history of late ventricular dilation (ie, dilation in excess of that seen at the time of diagnosis of PV-IVH). Infants fell into two groups: (1) posthemorrhagic hydrocephalus (PHH), dilation that produced an increase in occipitofrontal circumference greater than 2 cm per week and/or clinical symptoms of increased intracranial pressure; and (2) ventriculomegaly (VM), dilation that stabilized or reversed without producing these effects. The former was directly related to the severity of hemorrhage. The diameter of the lateral ventricle was significantly greater in PHH. In 26 of 48 infants at risk, late dilation developed: 14 had VM and 12 had PHH. Thus, late ventricular dilation stabilized or resolved spontaneously in 54%. Only three infants eventually required a ventriculoperitoneal shunt. Clinical changes in addition to ventricular size should be used in assessing the need for treatment of ventricular dilation after PV-IVH.
Subject(s)
Cerebral Hemorrhage/complications , Cerebral Ventricles/pathology , Infant, Premature, Diseases/complications , Cerebral Ventricles/physiopathology , Cerebral Ventricles/surgery , Dilatation, Pathologic , Drainage , Humans , Hydrocephalus/etiology , Hydrocephalus/surgery , Infant, Newborn , Intracranial Pressure , Spinal Puncture , UltrasonographyABSTRACT
The ultrasound sector scanner was used to visualize intracranial pathologic conditions in neonates. The scan head is small enough to make good contact with the anterior fontanelle of infants as small as 700 to 800 g. Clotted blood is clearly seen as a white, echo-dense area, and the scan quality approaches that of computerized tomographic (CT) scan in neonates with intracranial hemorrhage. Three cases were analyzed with CT scan or by autopsy correlation of sector scans. Clinical applications include the diagnosis of periventricular-intraventricular hemorrhage, posthemorrhagic hydrocephalus, and other intracranial pathologic conditions. The use of ultrasound in the diagnosis of neonatal intracranial hemorrhage is briefly reviewed.
