Focal Ischemic Cerebral Injury in the Newborn: Diagnosis by Ultrasound and Correlation with Computed Tomographic Scan

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Abstract
Ischemic brain injury in the newborn is a common cause of subsequent neurologic deficits seen in older children. Clearly, determination of severity and location of such injury is important for management and prognosis. Although ultrasound scanning of the brain has been used extensively in the premature infant for diagnosis of hemorrhagic lesions, its use in the term infant for recognition of ischemic cerebral lesions has not been reported. Four cases are described in which focal echodense areas were identified on ultrasound scan of the brain. These echodense areas on ultrasound corresponded to the appearance on computed tomographic (CT) scan of areas of decreased density which are known to represent ischemic cerebral injury. In 3 of the 4 cases there were focal neurologic findings and/or focal abnormalities on EEG. In 2 cases, real-time ultrasound scanning demonstrated changes in arterial pulsations in cerebral vessels in the area of the lesions. Thus, in both, there was diminution in pulsations within the echodense areas and in 1 case, an increase in pulsations was observed at the periphery of the echodense lesion. Our data demonstrate the value of ultrasound scanning for assessment of the extent and location of focal cerebral ischemic lesions in the newborn. Such assessment permits assessment of prognosis.