Role of Neurosonography in the Management of Neonatal Intracranial Lesions
Kerbala Journal of Medicine,
2017, Volume 10, Issue 1, Pages 2634-2640
ackground: Neurosonography is an important test in the diagnosis of hemorrhage and other acquired and congenital brain pathology of the newborn, despite the advances in computed tomography (CT) and magnetic resonance imaging (MRI), ultrasound is still the only modality able to image the brain at the bedside, which can be vitally important in the case of the critically ill infant. Whereas CT and MRI require sedation for optimal imaging, US can be done without incurring the risks associated with sedation. Also of benefit to the newborn is that ultrasound is easily reproducible and does not produce any ionizing radiation.
Aim of the study:
1. To analyze prospectively the value of neurosonography versus CT scan for the assessment of suspected intracranial lesions.
2. To evaluate the significance of CT imaging after brain ultrasound and whether it change the patient management.
Methods: This is a cross sectional descriptive study in which a forty two full-term neonates were prospectively studied in Kerbela teaching hospital for children between April 2015, and September 2016. Brain ultrasound was done for them for various presentations (seizure, big head, small head, birth asphyxia, bulging fontanel, declining hemoglobin, central apnea/bradycardia, and lethargy)
Then CT scan requested for them by radiologist, pediatrician or neurosurgeon.
Results: There were 26 male and 16 female neonates.
The main findings on US were
Hydrocephaly (14), Intracranial bleeding (9), Cystic lesions (8), Brain edema (6), Normal (5)
In the present study, 14 cases of hydrocephalus were diagnosed by US, and were confirmed by CT scan of brain, the results were completely similar in 6/14 of cases, and were partially concordant in the remaining 8 cases.
Regarding intracranial hemorrhage in 6 of 9 cases, there is complete concordance between ultrasound and CT findings while there is partial concordance in the remaining 3 cases.
For cystic brain lesion, in 6 of 8 cases there is no concordance between the findings, one of 8 showed complete concordance while the last one showed partial concordance.
In brain edema, 6 detected by ultrasound, 5 of them confirmed by CT scan, while the 6th were normal.
In the present study 5 cases appeared normal by ultrasound and CT.
Conclusions: Transfontanellar ultrasound is the first step when performing an intracranial evaluation in neonates as it is informative, bed side, cheep and available
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