Echogenic periventricular halo: normal sonographic finding or neonatal cerebral hemorrhage

Intracranial sonographic evaluation of the normal neonate frequently reveals an echogenic halo about the lateral ventricles. This periventricular halo is seen to varying degrees when scanning in both semiaxial and parasagittal planes in almost all normal infants. Among 180 consecutive premature neonates scanned serially with real-time sonography, two were prospectively diagnosed as having a form of periventricular echogenicity that was abnormal and represented periventricular hemorrhage. This hemorrhage completely surrounded the lateral ventricles and was intensely echogenic, as echogenic as the choroid plexus. This abnormal periventricular echogenicity was reproducible from multiple scan planes and hemorrhage was confirmed by computed tomography (CT). By contrast, CT scans obtained on another 53 of the 180 premature infants failed to reveal evidence of any abnormality corresponding to the periventricular echogenicity. Both neonates with periventricular hemorrhage developed bilateral multiseptate areas of porencephaly as sequelae to their hemorrhages. The differentiation between normal periventricular echogenicity and periventricular hemorrhage therefore attains great significance to the sonographer.