Neurosonography of the brain of newborns
Neurosonography is a study of the brain of children of the first year of life using ultrasound.This diagnostic method is completely painless and not dangerous, therefore it is widely used in newborns.Indications for neurosonography are prematurity, oxygen starvation, intrauterine infection, birth trauma, and many other conditions in which central nervous system( CNS) structures can be damaged.Table of contents: Features of neurosonography To whom is neurosonography shown?Pathologies diagnosed with neurosonography How the
is Understanding Neurosonography
Ultrasound scanning is a highly informative method for studying virtually all organs.With the help of ultrasound, it is impossible to study only bones and anatomical structures in which there is air.In addition, due to the fact that the human skull consists of a dense bone tissue that does not let out ultrasonic waves, certain difficulties arise with ultrasound of the brain.However, for children under one year, this is not a problem: there are holes in their skull, through which the central organ of the central nervous system can be easily examined.
Neurosonography is performed through a large fontanel - this is the basic access of .If necessary, in more detail to consider certain structures of the brain, the physician can take advantage of additional access: the temporal region, in which the bone has the smallest thickness, a large occipital opening, anterior and posterolateral fontanelles.
After a year to examine the brain with ultrasound is already heavier( transcranial ultrasound is much less informative), so small patients have to do a computer tomography or other studies.What is the neurosonography?
Due to the fact that neurosonography is an accessible, safe and highly informative diagnostic method, it is desirable to pass it to all newborn children.There are several reasons for this:
- High sensitivity of the brain to the effects of negative factors.Neither parents nor doctors can be absolutely sure that the child does not have any organic changes from the nervous system, since they do not manifest immediately.
- The need to identify the pathologies of the brain in the shortest possible time. It is believed that up to a year the child and doctors have an "open therapeutic window" that allows to correct the detected neurological disorders .At this age, the brain is the most plastic and capable of recovery.Therefore, the sooner treatment is started, the greater the likelihood that the most unpleasant consequences of a negative impact on the central nervous system will be avoided.
That is, if the doctor in the hospital or in the clinic recommends to undergo an ultrasound examination, do not give up.Harm from this procedure and discomfort for the baby will not, the children tolerate it is absolutely normal - many do not even wake up during the study.
However, in some situations, parents do not have to think about, because for their kids neurosonography is a mandatory research. Indications for its implementation are:
- Severe condition of the child, requiring resuscitation.
- Postponed hypoxia.
- Intrauterine infection.
- Birth injury.
- The use of obstetric aids( for example, forceps, extraction of the child from the birth canal of the mother behind the pelvic end).
- Developmental flaws.
- An unusual shape of a newborn's head or face.
- Low mass of the baby at birth( intrauterine hypotrophy).
- The appearance of any neurologic symptoms.
Pathologies diagnosed by neurosonography
Neurosonography is a very effective diagnostic method. With its help, it is possible to detect pathological changes in the vascular bed, the ventricular system, the structures of the brain( large hemispheres, cerebellum, trunk, etc.).However, there are diseases in which disturbances occur at the cellular or gene level, so it is not possible to detect them with conventional ultrasound or any other instrumental study.Similarly, the abnormal neurosonographic picture is not always accompanied by clinical symptoms.All this confirms the necessity for the diagnosis of evaluation in the complex of all data: the results of a neurological examination, and information obtained during an ultrasound scan or other research methods.
Consider the diseases that are most often diagnosed in children using neurosonography.
Vascular plexus cysts is a fairly frequent ultrasound finding that scares parents very much.In fact, these cysts are formed in virtually all children at the stage of intrauterine development, it is simple in most newborns that they disappear before birth. This pathology does not require treatment and passes on its own without causing any clinical symptomatology of .
Arachnoid cysts is a malformation of the arachnoid membrane of the brain.The localization and size of such cysts are very variable.Small formations( up to 2-3 cm), as a rule, do not disturb patients, and larger cysts can squeeze the structures of the brain and thereby provoke various neurological disorders.Another feature of such cysts is a tendency to grow, that is, initially a small cyst may increase with time.In this regard, arachnoid cysts require serious medical supervision and compulsory treatment.
Hypertensive syndrome - increased intracranial pressure.All structures of the brain are washed by cerebrospinal fluid.This fluid is produced by the vascular plexuses and circulates in the ventricular system and subarachnoid space.If an obstruction appears on the way of the cerebrospinal fluid( eg, a hematoma or a large cyst), the pressure inside the skull rises and various neurological symptoms appear.
Hydrocephalus( edema of the brain) is a pathology in which ventricles and subarachnoid space create and accumulate too much CSF, as a result of which the cerebrospinal fluid expands. Patients with this pathology require serious treatment( usually surgical).
Hemorrhage - is one of the most severe brain pathologies of .Hemorrhages in the brain are intraventricular and parenchymal.Both are dangerous.The most typical occurrence of hemorrhages for premature infants, especially deeply premature babies.The clinical manifestation and prognosis for the further life of the child depends on the degree of hemorrhage.At the first degree, both the baby and the parents can "get off with a slight fright," but the more severe hemorrhages almost always leave after themselves the consequences - various neurological disorders of .After resorption of large intracerebral hematomas on the site of the nervous tissue, porentsefal cysts are formed, respectively, the affected area of the brain loses its functionality.
Separately, subarachnoid, subdural and epidural hematomas are isolated - localized under or above the brain envelopes.They arise most often due to birth trauma and blood clotting disorders in the child.The prognosis for patients depends on how much blood has accumulated. Small hemorrhages dissolve completely, large ones also gradually resolve, but has time to exert its detrimental impact on nervous structures.
Hypoxic-ischemic brain injury is a lesion caused by a lack of oxygen that occurs in utero, during labor and after childbirth.A mild hypoxic lesion requires only observation of the newborn in the dynamics( repeated neurosonography, etc.) and passes, does not leave undesirable health effects.But in more severe cases, the nerve cells die with the formation of zones of leukomalacia.For premature babies, the most typical ischemic lesion of the central parts of the brain( located near the ventricles), its consequence - periventricular leukomalacia. In full-term children, the areas near the cerebral cortex and bark are most vulnerable.
In addition to all of the above, ultrasound can detect infectious inflammatory processes of the brain and its membranes, as well as congenital anomalies of brain structures( eg, underdevelopment of one hemisphere, etc.).
How is the
carried out? To conduct a neurosonography, the child is laid on the couch, the mother at this moment can be near and hold the baby.It is desirable that the child does not disturb anything during the examination( that is, he should be dry and not hungry).Preterm infants who are in the cuvette, neurosonography can be performed directly in the intensive care unit.Such a study in no way affects the baby's well-being and does not interfere with the treatment.
To improve the transmission of ultrasonic waves to the scalp of a small patient, the doctor applies a conductive gel.Then, using a special sensor, he studies the structure of the brain.That is, in fact, the procedure of neurosonography is not particularly different from the procedure of conventional ultrasound.
Zubkova Olga Sergeevna, medical reviewer, epidemiologist