Cerebrovascular accidents in neonates treated with extracorporeal membrane oxygenation: sonographic-pathologic...

Neonates treated with extracorporeal membrane oxygenation are at high risk for the development of intracranial hemorrhage and infarction. The appearance of these lesions on cranial sonography is often unusual and may be confusing. We compared the findings at autopsy with premorbid cranial sonograms in 17 nonsurviving neonates to define better the anatomic basis for the sonographic appearance of these lesions. Macroscopic abnormalities were identified at autopsy in 13 of the 17 neonates. Five neonates had multifocal hemorrhagic white-matter infarcts, three had large parenchymal hemorrhages with adjacent areas of parenchymal necrosis, three had hemorrhagic infarcts of the cerebellum, one had a germinal matrix and intraventricular hemorrhage, and one had bilateral periventricular cysts with surrounding gliosis. All 17 neonates had abnormalities on microscopic examination. Although sonography was accurate in the detection of macroscopic lesions (11 of 13 lesions detected with sonography), the nature and extent of these abnormalities were difficult to judge because of the variable echogenicity of unclotted blood and the presence of focal areas of abnormal echogenicity associated with microscopic calcification and gliosis. Sonography is excellent for the detection of acute cerebrovascular complications during extracorporeal membrane oxygenation, but the appearance of these lesions is variable and nonspecific.