MKP ANTENATAL - keywords
antenatal intracranial haemorrhage
old clot
*
antenatal ventriculomegaly;
term, first day scans, dilatation
of all but the fourth ventricle
suggests aqueduct stenosis
haemorrhagic nature:
hyperechoic, nodular ependymal
lining and clot remnants
scattered throughout the
ventricle system; cystic changes
within right parietal lobe (*)
no genetic diagnosis
first day CUS of two term infants with petechiae and severe
thrombocytopenia (platelets < 20x109/L); in both HPA1 platelet
antigen alloimmunization started in utero, with ensuing intracranial
bleeding long before delivery
*
old clot
hyperechoic
ependyma
v3
temporal cavitating haematoma
old clot
porencephalic
defect
antenatal unilateral hydrocephalus;
term; familial epistaxis
postnatal additional sonographic
information (first day): old clot due
to IVH and right porencephalic defect
following venous infarction
haemostatic screen of newborn:
von Willebrand disease
porencephaly
clot remnants
dilated v3
infant with occipital porencephaly,
hydrocephalus and residual frontal clot against
the ependyma; mild mental retardation and
severe visual sequelae
antenatal ischaemic injury to thalamus
two term infants with hypertonia and lowered consciousness from birth,
difficult swallowing and persistent hyperchoic changes in thalamus (from day
1) and limited T1 hypersignal in thalamus without acute diffusion restriction;
negative infectious and metabolic diagnostic tests
germinolysis in
caudothalamic groove
germinolysis in
caudothalamic groove
hyperechoic bilateral and symmetrical ventrolateral thalamus
T1 hypersignal in ventrolateral thalamus
germinolysis in
caudothalamic groove
questionable T1 hypersignal in
ventrolateral thalamus
hyperechoic bilateral and symmetrical ventrolateral and medial thalamus
courtesy neonatal unit Joan de Deu, Barcelona, Spain
antenatal ischaemic injury to thalamus
two term infants with hypertonia and lowered consciousness from birth, difficult swallowing and persistent hyperchoic changes in thalamus (from day 1) and
limited T1 hypersignal in thalamus without acute diffusion restriction; negative infectious and metabolic diagnostic tests
germinolysis in
caudothalamic groove
germinolysis in
caudothalamic groove
hyperechoic bilateral and symmetrical ventrolateral thalamus
hyperechoic bilateral and symmetrical ventrolateral and medial thalamus
germinolysis in
caudothalamic groove
T1 hypersignal in ventrolateral thalamus
questionable T1 hypersignal in
ventrolateral thalamus
courtesy neonatal unit Joan de Deu, Barcelona, Spain
porencephaly
no communication to ventricle
presumed in utero anterior trunkal MCA stroke
day 1
schizencephaly-like
day 28
additional left occipital
porencephalic lesion
term
home delivery at 27w GA; evolution from subacute infarction to porencephaly
simple porencephaly
multicystic encephalomalacia
routine first day CUS in a ventilated 32 w GA preterm; simple porencephaly at
the posterior frontal right lateral ventricle, subjacent to the rolandic area; this
most likely follows in utero venous medullary infarction
paraventricular porencephaly
schizencephaly
congenital haemorrhagic infarction leading to unilateral cerebellar hypoplasia
coronal view via nuchal fontanel
cisterna magna
defect of right
cerebellar
hemisphere
normal left
hemisphere
hyperechoic
infarct margin
v4
sulcus collateralis
mesencephalon
residual right
hemisphere
small hemosiderin
deposition
In susceptibility
weighted MRI
hypoplastic vermis
courtesy T Mühlbacher, Berlin
schizencephaly
mother assaulted at 22 w gestation, infant born at 35 wks: schizencephaly, septal agenesis and extensive polymicrogyria
coronal ultrasound
cleft
septal
agenesis
no communication with the
ventricle
axial T2 MRI
cleft
cleft
extensive
polymicrogyria
multicystic encephalomalacia
three monozygous twin pairs with extensive destruction of the cerebral
mantle in one twin, not compatible with an arterial template
cotwin normal
cotwin died in utero; scans at 2 weeks of age
axial T2
coronal FLAIR
day 1 CUS
acceptor in a twin to twin transfusion
syndrome with complete cerebral destruction
in the first month of life; the twin was born at
30 weeks of gestation, the donor died from
complete renal necrosis; the first day CUS had
only suggested flaring, suggesting the
ischaemic event was recently prenatal
ax T2 MRI second month
hydranencephaly
absent cortical mantle in ACA and MCA
territories
normal cerebellum and remnant
basilar artery terrain of cerebrum
separation at
diencephalon
normal cerebellum and remnant
basilar artery terrain of cerebrum
falx
present cortical mantle absent
and atrophic thalami
separated
axial
sagittal T2
courtesy L De Vries, Utrecht
parietal coronal detail
frontal coronal detail
frontal coronal
frontal coronal
hemispheres fused in
spite of midline
development
cortical mantle present
hemispheres fused
aqueduct atresia
semilobar holoprosencephaly
thalami fused
cobblestone lissencephaly (WalkerWarburg syndrome)
antenatal intracranial haemorrhage due to collagen 4A mutation
antenatal MRI (T2 HASTE sequence) pointing to temporal matrix haemorrhage
R
L
ipsilateral ventricular dilatation
R
small left porencephaly
neonatal CUS
R
R
L
clot difficult to
visualise
posterior fontanel coronal
neonatal MRI
small left porencephaly
clot difficult to
visualise
clot easy to visualise
on SWI sequences
antenatal germinolysis
cystic leukomalacia
matrix
pockets
caudothalamic
germinolysis
lateral ventricle
caudate head
parafrontal
germinolysis
thalamus
temporal germinolysis
pf
ct
courtesy Altman & Bayer (2015)
geerminolysis in parafrontal (pf) and
caudothalamic (ct) areas
congenital rubella syndrome, bilateral cystic caudothalamic germinolysis
late preterm first day scans (dichorionic twin), left parafrontal germinolytic pseudocyst;
TORCH screen negative
antenatal germinolysis related to congenital cytomegalovirus infection
A
C
B
caudothalamic
germinolysis
temporal germinolysis
D
G
E
H
F
I
antenatal germinolysis related to inborn error of metabolism
caudothalamic
germinolysis
flat insular lobe
peroxisomal biogenesis disorder
with Zellweger phenotype
large cavum
septi pellucidi
caudothalamic
germinolysis
glutaric aciduria type II
pyridoxine-dependent
epilepsy due to ALDH7A1
mutation
large parafrontal
germinolytic cysts
cerebellar
hypoplasia
large parafrontal
germinolytic cysts
lenticulostriate vasculopathy
arteries affected, not veins
high resolution images of postnatal onset
arteriopathy in a preterm infant with GMH/IVH
recipient in twin to twin transfusion syndrome
candelabra in parasagittal scans
arteriopathy with congenital CMV infection
ichtyosis/prematurity/eosinophilia
antenatal brain injury in congenital heart disease
enlarged ventricular and extra-cerebral CSF spaces in a term infant with double outlet right ventricle and pulmonary atresia, scanned on day 2
MRI T2 at 6 weeks
ZIKA virus fetopathy with brain disruption sequence
subcortical calcification
skull collapse
term neonate, first
day scans
subcortical calcification
arteriopathy
T1-weighted
relatively normal hindbrain
gradient echo
T2-weighted
calcified spots in
striatum and subcortex
ventriculomegaly, enlarged
subarachnoid spaces and
extensive polymicrogyria
subependymal pseudocysts
Aicardi-Goutières syndrome
coronal
parasagittal
term infant with progressive microcephaly in early infancy, psychomotor
retardation, spasticity, feeding problems, recurrent seizures; normal
platelet count, normal liver enzymes; increased CSF lymphocytosis
RNASEH28 pathogenic variant
scans in the fourth month of life
parasagittal
bilateral but asymmetric hyperechoic changes in striatum and thalamus; hyperechoic white matter
CT
parasagittal
doppler
T1-weighted
calcification in white
matter, sriatum and
cerebellum
T1-weighted
calcification of the postcentral artery
T1-weighted
T2-weighted
pseudo-Torch 1
term infant with severe microcephaly and clinical seizures, scans in week 1
coronal
T1 coronal
T1 axial
calcification in white matter
calcification in white matter
calcification in thalamus
SSWI
parasagittal
hypoplastic corpus callosum
parasagittal
shrunken hyperechoic thalamus
insular triangle not visualised
NF1A-related disorder
term infant with hydronephrosis and
dysmorphic features
ventriculomegaly
cerebellar hypoplasia
calcification in white matter
courtesy S Horsch, Berlin
iron-sulfur cluster assembly gene IBA57
generalized hypotonia, respiratory insufficiency, arthrogryposis, microcephaly, hyperglycinemia
abnormal thick cortical plate
no pontocerebellar hypoplasia
ventriculomegaly ex vacuo
active cortical necrosis on diffusion
weighted MRI
neither calcification nor haemorrhage
subacute and recent cell death
antenatal detection of asymmetrical cortical anomalies: closed schizencephaly
near term infant
calcification in an area of abnormal migration
axial T2
cystic germinolysis
parasagittal right
ventricle out-dentation
Zellweger syndrome
coronal
<— cystic germinolysis
irregular ventricular dilatation without ballooning
extensive cystic germinolysis
parasagittal
ADC map
axial T2
<— cystic germinolysis
flat insular triangles
<— mild lenticulostriate arteriopathy
perisylvian polymicrogyria
term, hypotonia, clinical seizures, kidney cysts; homozygous mutation PEX6 gene
antenatal ischaemic injury to the pons
two term infants with Möbius sequence; comparison of sagittal cranial ultrasound images with axial CT and MRI images
CT
T1MR
CT
sublte calcification in the dorsal brainstem is visible on ultrasound and CT, not on MRI
poor quality ultrasound scans several decades old
antenatal onset injury to pallidum due to mitochondrial disorder with neonatal lactic acidosis
term, heart failure, cloudy corneae
term, heart failure
< — high T1 signal in pallidum
very hyperechoic globus pallidus
hypoplastic vermis
courtesy Jeroen Dudink Utrecht
inborn errors of metabolism
CDG syndrome
non-ketotic hyperglycinaemia
genetic mitochondrial disorder
< — large
germinolytic cyst
thin splenium
large pericerebellar spaces
corpus callosum sunken between ventricles
< — cyst
< — cyst
vermis hypoplasia
dysgenetic (hypoplastic) corpus callosum