Ultraschall in Med
DOI: 10.1055/a-0978-8280
Pictorial Essay
© Georg Thieme Verlag KG Stuttgart · New York

Sonographic Diagnosis of Neonatal Hypoxic-Ischemic Encephalopathy – Part I: Lesions of Deep Nuclear Structures – Basal Ganglia and Thalamus

Sonografische Diagnose der neonatalen hypoxämisch-ischämischen Encephalopathie – Teil I: Läsionen von Basalganglien und Thalamus
Karl-Heinz Deeg
Pediatric Clinic, Universitiy of Erlangen/Nuremberg, Erlangen, Germany
› Author Affiliations
Further Information

Publication History

25 June 2019

17 July 2019

Publication Date:
02 September 2019 (online)

Introduction

Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the most common causes of cerebral palsy and other severe neurological deficits in children. Neonatal HIE occurs in 1.5/1000 live births (Bano S et al., Neonatal hypoxic-ischemic encephalopathy: A radiological review. J Pediatr Neurosci 2017; 12: 1–6). It is caused by inadequate blood flow and oxygen supply to the brain resulting in focal or diffuse brain injury. The pattern of brain injury depends on the severity and duration of hypoxia and degree of brain maturation. The cerebral lesions in full-term neonates (> 36 weeks of gestation) differ from those in preterm neonates (< 36 weeks of gestation). Neuroimaging modalities such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) help with the identification and characterization of the accurate location, extent, and severity of the brain injury.

In full-term infants moderate insults cause cortical and subcortical lesions, whereas severe and prolonged insults may cause deep nuclear involvement including the basal ganglia, especially the head of the caudate nucleus, the putamen, the dorsal thalamus and the posterior limb of the internal capsule (Volpe JJ ed, Neurology of the newborn 6th ed, 2018; 484–563).

The imaging method of choice for the various cerebral lesions is MRI (Barnette AR et al. Neuroimaging in the evaluation of neonatal encephalopathy. Pediatrics 2014; 133: 1508–1517; Bano S et al., Neonatal hypoxic-ischemic encephalopathy: A radiological review. J Pediatr Neurosci 2017; 12: 1–6).

In the Vermont Oxford network neonatal encephalopathy registry, 4171 full-term infants were diagnosed with encephalopathy in the first 3 days of life. The authors compared cerebral US with CT and MRI (Barnette AR et al. Neuroimaging in the evaluation of neonatal encephalopathy. Pediatrics 2014; 133: 1508–1517). They found that MRI and CT were more sensitive than cranial ultrasound especially for the demonstration of deep brain abnormalities (Barnette AR et al. Neuroimaging in the evaluation of neonatal encephalopathy. Pediatrics 2014; 133: 1508–1517).

The presented paper shows that high-resolution cerebral ultrasound may be able to visualize damage of the basal ganglia, thalamus and internal capsule in critically ill newborns in the intensive care unit.