| Findings: Initial Brain Ultrasound (fig.1-2):
1. Hyperechoic change of left corpus striatum (red arrows in fig.1,
2) and corona radiata (yellow arrow in fig.1) without
midline shift.
MRI of brain (5 days later) with T1 weighted echo train spin echo,
T2 weighted echo train spin echo, fluid-attenuated inversion
recovery echo train spin echo, MR diffusion imaging, short
inversion time inversion recovery echo train spin echo, time-of-
flight MR angiogarphy with 3D maximum-intensity projection
reconstruction, and without intravenous contrast (fig.3-9): 1. Lobulated long T2 change (red arrows in fig.4,5) with significant
restricted water diffusibility (red arrows in fig.7,8) in left
corpus striatum, at least including caudate nucleus and both
anterior (yellow arrows in fig.7,8) and posterior (green arrows in
fig.7,8) limbs of internal capsule, and extension into medial (blue
arrows in fig.7,8) and middle (pink arrows in fig.7,8) base of
left cerebral peduncle in midbrain, suggesting neonatal brain
infarction with at least left deep cerebral nuclei and
corticospinal and frontopontine tracts involvement.
2. Focal heterogeneous short T1 and dark T2 (orange arrows in fig3-6)
change within the lesion at left lentiform nucleus and corona
radiata, in favor of post infarction hemorrhagic transformation
with intracellular methemoglobin accumulation.
3. No detectable abnormal finding in intracranial arteries,
including left middle cerebral artery (red arrow in fig.9).
Follow up brain ultrasound with power Doppler images (fig.10-12):
1. Decreased the high echogenic signal in left corpus striatum
(red arrows in fig.10) compared to previous ultrasound (fig.1).
2. No detectable abnormal finding in intracranial arteries,
including left middle cerebral artery (red arrow in fig.11). |
071204 NEONATAL HEMORRHAGIC INFARCTION
