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Updated: Feb 13, 2026
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Sonographic Diagnosis of Meningoencephalitis in Newborns and Infants
1Pediatric Clinic of the Social Foundation of Bamberg, Bamberg, Germany.
Insights
Ultrasound effectively diagnoses serious brain infections and complications in infants, including hydrocephalus and abscesses. This imaging technique is crucial for identifying prenatal infections and late sequelae, often negating the need for MRI.
Area of Science:
- Pediatric Neurology
- Medical Imaging
- Infectious Diseases
Background:
- Brain infections in infants, including prenatal, neonatal meningoencephalitis, and those in older infants, frequently lead to severe complications.
- Common complications include postmeningitic hydrocephalus and subdural effusions.
- Rarer, yet serious, complications like brain abscesses and ventriculitis are often caused by gram-negative bacteria.
Purpose of the Study:
- To highlight the diagnostic capabilities of sonography (ultrasound) in identifying various brain infections and their complications in infants.
- To detail specific ultrasound findings associated with different types of infections and their sequelae.
- To emphasize the utility of ultrasound as a primary diagnostic tool, often reducing the need for advanced imaging.
Main Methods:
- Sonography through open fontanelles for prenatal and neonatal brain infections.
- Color Doppler and Spectral Doppler for assessing cerebral perfusion and flow velocities.
- Correlation of specific echogenic patterns with causative agents and complications.
Main Results:
- Ultrasound effectively diagnoses hydrocephalus, subdural effusions, brain abscesses, and ventriculitis.
- Distinct echogenic patterns identify fungal infections (multifocal lesions) and specific prenatal infections like cytomegalovirus, rubella, herpes, toxoplasma, and HIV (stripe-like basal ganglia lesions).
- Doppler ultrasound reveals altered brain perfusion (increased in acute phase, decreased in abscesses/infarcts) and increased flow velocities indicative of increased intracranial pressure.
Conclusions:
- Sonography is a highly effective, non-invasive method for diagnosing a wide spectrum of brain infections and complications in infants.
- Ultrasound findings can guide treatment and prognosis, differentiating between various infectious agents and sequelae.
- Advanced imaging like MRI is typically reserved for cases not definitively diagnosed by ultrasound.
Abstract:
Prenatal, neonatal meningoencephalitis and infections of the brain in older infants are often associated with serious complications which can be diagnosed by sonography through the open fontanelles. Most frequently postmeningitic hydrocephalus and subdural effusions occur. Rarer complications are brain abscesses and ventriculitis which are caused by gram negative bacteria such as E. coli, Serratia marcescens, Proteus and Enterobacter. A serious complication after ventriculitis is the development of compartment hydrocephalus. Multifocal small echogenic lesions scattered all over the brain are suspicious of fungal infections. Stripe-like echogenicities in the basal ganglia of newborns are typical for prenatal infections such as infections with cytomegalovirus, rubella, herpes, toxoplasma gondii and HIV. Late sequelae are intracranial cysts, multifocal encephalomalacia and intracranial calcifications. Color Doppler shows increased perfusion of the brain in the acute phase of the disease. Brain abscesses and infarcts are characterized by decreased or missing perfusion. Spectral Doppler shows increased flow velocities. Increased intracranial pressure causes an increase of the flow velocities in the intracranial part of the internal carotid artery in comparison with the extracranial part. All complications can be diagnosed by ultrasound. Other imaging methods such as MRI are only occasionally necessary.
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