[Real-time sonography in the evaluation of peri- and intraventricular cerebral hemorrhage]

Of 1776 sonograms done on 1312 patients with sector real time equipment, 923 done on 670 patients were selected because of suspected peri and intraventricular cerebral hemorrhage. The studies demonstrated hemorrhage in only 117 patients. It was possible to follow 107 patients and in 6.8 the hemorrhage was grade I, in 14 children it was grade II, in 19 it was grade II and in 6 it was grade IV. Most of the children (82 of 107) were pre-term (the average gestational age was less than 32 weeks). Twenty-three were term and two were post term. In most instances, the grade I hemorrhage resolved without sonographic or neurological sequelae, but in ten patients the hemorrhagic focus was replaced by a "cyst" which resolved in seven to more than 204 days; and in two it was replaced by a porencephalic cyst, which in one of the patients could still be seen at 134 days (when the last study was performed). All patients with grade II hemorrhage were pre-term (average gestational age of 33.1 weeks). Sonographic follow-up of these patients showed that hemorrhagic foci were not visible after 84 days (time of the last sonogram) and that only two children had slight hydrocephaly. Most of the children with grade III hemorrhage (75%) were premature (average gestational age of 32 weeks), and the others (25%) were at term. This was the group in which the greatest number of sonographic sequelae (e.g. hydrocephaly and/or atrophy) were observed. Also in this group more serious neurological sequelae were found. Grade IV Hemorrhage was found in the smallest number of patients but it had the worst prognosis: 2 of 2 premature babies died; 1 of 3 term babies died at 14 days after birth, another develop hydrocephaly and was operated on (developed cerebral palsy) and the third one was lost to follow up. A post term child with grade IV hemorrhage is being followed in the high risk clinic (at 10 months she has neurological sequelae which are not severe). At times it is difficult to differentiate grade IV hemorrhage from other conditions such as leukomalacia and/or peri-ventricular infarct. Real time sonography, performed through the anterior fontanelle has been shown to be very useful in the diagnosis and follow-up of peri and intraventricular cerebral hemorrhage.