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brain D algorithm n a v i g a t o r how to navigate CUS anatomy algorithms deep grey matter cortex matrix > white matter primary sulci select yellow region ——> colofon other entities midline ventricles, fluid spaces CerebrUS: diagnostic algorithm for perinatal brain injury 3D model hindbrain and cerebellum vessels functional anatomy eurUS.brain lectures item progress unilateral or asymmetrical < —> antenatal bilateral thalamic injury (lenticulostriate) arteriopathy peri- or postnatal injury to deep grey matter due to asphyxia phosphate precipitation kernicterus hypernatremic dehydration A toxic injury (CO, ) r e f e r e n c e s perinatal perforator stroke bilateral symmetrical deep grey matter haematoma abscedation thalamic lesions V postnatal onset hyperechoic germinolysis antenatal cystic germinolysis germinal matrix haemorrhage supratentorial white matter haematoma - - - antenatal porencephaly of venous type leukomalacia due to asphyxia medullary vein infarction encephalitis, viral preterm white matter injury lobar haematoma encephalitis, bacterial air and precipitation septal empyema midline cavity focal change lipoma midline venous infarction antenatal damage to brainstem or spinal cord cerebellar arterial ischaemic stroke unilateral cerebellar atrophy or partial destruction extensive cerebellar destruction hindbrain cerebellar abscedation cerebellar leukomalacia cerebellar haemorrhage cord stroke and laceration brainstem asphyxia cerebellar cortical dysplasia thalamo-ventricular haemorrhage intraventricular haemorrhage plexus pseudocyst extra-axial haematoma plexus haemorrhage or hygroma hydrocephalus/ventriculomegaly fluid spaces subdural haematoma epidural haematoma plexus hypertrophy intradural haematoma ventriculitis plexus tumor antenatal clastic hydrocephalus changes in choroid plexus tissue destruction by inborn error of metabolism neurodegenerative disorder parenchymal tumour ————> What are clues to the prenatal origin of a lesion ? (1) a previous sib may have been affected,, indicating a common noxious agent or a genetic disorder with vasculopathy, metabolic disorder or cardiac failure (2) the maternal history may be highly suggestive (3) anomalous fetal ultrasound (or MR) findings may have been observed (4) fetal CTG and flow findings may be diagnostic (5) typical clinical phenotypes may be indicative: - seizures in the delivery room - the fetal hypokinesia sequence - fetofetal or fetomaternal transfusion (6) postmortem evidence of antenatal damage may be found (7) finally, early neonatal ultrasound imaging and confirmation with MRI or CT of a lesion antedating the delivery is the cornerstone of detection of fetal brain damage prenatal injury extracellular metHb early clot retraction, clot center hypoechoic change, fibrin strands deoxyHb hypoechoic particulate cerebrospinal fluid, with motion during doppler imaging hyperechoic ependyma w 2-4, clot with grey center and white border hemosiderin intracellular metHb clues during CUS ---------------------- - a parenchymal hyperechoic lesion seen on admission immediately after birth is likely of antepartum origin - after a few days clot in a ventricle begins to undergo lysis, giving rise to cavitation within; the coagulum starts to retract leaving irregular intraluminal structures with a dense ridge and a hypoechoic centre - towards the end of the first week, following a sterile reaction to blood, the ependyma becomes hyperechoic and granular in some spots, a phenomenon that is to persist for weeks [Rypens et al. 1994] - widening of the ventricle without bulky clot presence is an argument for subacute or chronic staging - associated lesions in white matter, if cystic, can point to the subacute character of the event - exceptionally haemorrhage in plexus choroideus or germinal matrix may evolve into a growing hygroma with a capsule analogous to that of a chronic subdural haematoma - as a rule ischaemic echogenicities persist for several (≥ 2) weeks, whereas any haemorrhagic area should be cleared of most echoic foci in two to three weeks solid, hyperechoic porencephaly; clot remnants for a few months; best seen in susceptibility weighted MR sequences vascular anomaly arteriopathy venous haemorrhage congenital anomaly of a large artery arteries: 3D model veins are involved in many lesions, almost always haemorrhagic; the mechanistic approach to venous injury can yield findings that are important for management basal vein of Rosenthal spasm or compression arterial tortuosity Group publications. 1: Alarcón A, Carreras N, Muehlbacher T, Casas-Alba D, Arena R, Roca-Llabrés P, Navarro-Morón J, de Vries LS, Govaert P; EurUS.Brain group. Foetal disruptive brain injuries: Diagnosing the underlying pathogenetic mechanisms with cranial ultrasonography. Dev Med Child Neurol. 2025 Nov;67(11):1383-1408. doi: 10.1111/dmcn.16380. Epub 2025 Jul 13. PMID: 40653787; PMCID: PMC12521638. 2: Licht-van der Stap RG, de Vries LS, Alarcon A, Govaert P, Steggerda SJ; EurUS.Brain group. Cranial ultrasound in neonatal brain infections. Dev Med Child Neurol. 2025 Aug;67(8):986-1003. doi: 10.1111/dmcn.16279. Epub 2025 Feb 25. PMID: 39996578; PMCID: PMC12237230. 3: Valverde E, Ybarra M, Bravo MC, Dudink J, Govaert P, Horsch S, Steggerda S, Pellicer A; EurUS.Brain Group. State-of-the-art cranial ultrasound in clinical scenarios for infants born at term and near-term. Dev Med Child Neurol. 2025 Mar;67(3):322-347. doi: 10.1111/dmcn.16133. Epub 2024 Oct 21. PMID: 39432744. 4: Govaert P, Arena R, Dudink J, Steggerda S, Agut T, Marissens G, Hoebeek F; EurUS.Brain group. Developmental anatomy of the thalamus, perinatal lesions, and neurological development. Dev Med Child Neurol. 2025 Jan;67(1):15-34. doi: 10.1111/dmcn.15992. Epub 2024 Jun 14. PMID: 38875159. 5: Horsch S, Schwarz S, Arnaez J, Steggerda S, Arena R, Govaert P; EurUS.Brain group. Cerebral Doppler imaging in neonates: A guide for clinical application and diagnosis. Dev Med Child Neurol. 2024 Dec;66(12):1570-1589. doi: 10.1111/dmcn.15998. Epub 2024 Jun 28. PMID: 38940604. 6: Bravo MC, Lubian S, Horsch S, Cabañas F, de Vries LS; EurUS.Brain group. Neonatal ventriculomegaly: Pathophysiology and management guided with cranial ultrasonography. Dev Med Child Neurol. 2024 Nov;66(11):1419-1431. doi: 10.1111/dmcn.15955. Epub 2024 May 15. PMID: 38747316. 7: Arena R, Gallini F, De Rose DU, Conte F, Giraldi L, Pianini T, Perri A, Catenazzi P, Orfeo L, Vento G, Govaert P. Brain Growth Evaluation Assessed with Transfontanellar (B-GREAT) Ultrasound. Old and New Bedside Markers to Estimate Cerebral Growth in Preterm Infants: a Pilot Study. Am J Perinatol. 2024 Mar;41(4):488-497. doi: 10.1055/a-1704-1716. Epub 2021 Nov 23. PMID: 34814194. 8: Govaert P, Roehr CC, Gressens P. Cranial ultrasound by neonatologists. Pediatr Res. 2020 Mar;87(Suppl 1):1-2. doi: 10.1038/s41390-020-0779-8. PMID: 32218540; PMCID: PMC7098880. 9: Dudink J, Jeanne Steggerda S, Horsch S; eurUS.brain group. State-of-the-art neonatal cerebral ultrasound: technique and reporting. Pediatr Res. 2020 Mar;87(Suppl 1):3-12. doi: 10.1038/s41390-020-0776-y. PMID: 32218539; PMCID: PMC7098885. 10: Annink KV, de Vries LS, Groenendaal F, Vijlbrief DC, Weeke LC, Roehr CC, Lequin M, Reiss I, Govaert P, Benders MJNL, Dudink J. The development and validation of a cerebral ultrasound scoring system for infants with hypoxic- ischaemic encephalopathy. Pediatr Res. 2020 Mar;87(Suppl 1):59-66. doi: 10.1038/s41390-020-0782-0. PMID: 32218538; PMCID: PMC7098882. 11: Fumagalli M, Parodi A, Ramenghi L, Limperopoulos C, Steggerda S; eurUS.brain group. Ultrasound of acquired posterior fossa abnormalities in the newborn. Pediatr Res. 2020 Mar;87(Suppl 1):25-36. doi: 10.1038/s41390-020-0778-9. PMID: 32218537; PMCID: PMC7098891. 12: Camfferman FA, de Goederen R, Govaert P, Dudink J, van Bel F, Pellicer A, Cools F; eurUS.brain group. Diagnostic and predictive value of Doppler ultrasound for evaluation of the brain circulation in preterm infants: a systematic review. Pediatr Res. 2020 Mar;87(Suppl 1):50-58. doi: 10.1038/s41390-020-0777-x. PMID: 32218536; PMCID: PMC7098887. 13: Parodi A, Govaert P, Horsch S, Bravo MC, Ramenghi LA; eurUS.brain group. Cranial ultrasound findings in preterm germinal matrix haemorrhage, sequelae and outcome. Pediatr Res. 2020 Mar;87(Suppl 1):13-24. doi: 10.1038/s41390-020-0780-2. PMID: 32218535; PMCID: PMC7098890. 14: Agut T, Alarcon A, Cabañas F, Bartocci M, Martinez-Biarge M, Horsch S; eurUS.brain group. Preterm white matter injury: ultrasound diagnosis and classification. Pediatr Res. 2020 Mar;87(Suppl 1):37-49. doi: 10.1038/s41390-020-0781-1. PMID: 32218534; PMCID: PMC7098888. 15: Govaert P, Triulzi F, Dudink J. The developing brain by trimester. Handb Clin Neurol. 2020;171:245-289. doi: 10.1016/B978-0-444-64239-4.00014-X. PMID: 32736754. CerebrUS by eurUS.brain ESPR important references myelination ventral forebrain hypothalamus amygdala parcelation with US multicystic encephalopathy schizencephaly brain disruption sequence hypoglycaemia polymicrogyria inflammatory vasculopathy intra- or postpartum primary cortical injury due to asphyxia arterial porencephaly hydranencephaly cerebral hemiatrophy disorders of tight junction molecules pial arterial ischaemic stroke subpial/subarachnoid haematoma basement membrane disorder complex histological changes of the vessel wall bacterial meningitis watershed injury PRES focal cortical dysplasia/neuroectodermal disorder intrapartum asphyxia congenital brain tumour seizures: treatment sinovenous thrombosis GMH/IVH retinal haemorrhage jitteriness germinal matrix neuroepithelium lesion list seizures: causes brain arteries clinical algorithms disease entities seizures: clinical presentation arterial ischaemic stroke antenatal intracranial haemorrhage neonatal facial palsy term equivalent imaging cranial birth trauma seizures: diagnosis deep veins intracranial haemorrhage Darrow, V.C., Alvord, E.C. jr, Mack, L.A., Hodson, W.A. (1988) ‘Histologic evolution of the reactions to hemorrhage in the premature human infant’s brain. A combined ultrasound and autopsy study and a comparison with the reaction in adults. ‘ American Journal of Pathology, 130, 44-58. Ghazi-Birry H, Brown W, Moody D, Challa V, Block S, and Reboussin D (1977) Human Germinal Matrix: Venous Origin of Hemorrhage and Vascular Characteristics. AJNR Am J Neuroradiol 18:219-229. Larroche, J.-Cl. (1977) 'Developmental pathology of the neonate.' North-Holland : Elsevier.Marin-Padilla, M. (1996) ‘Developmental neuropathology and impact of perinatal brain damage. I : Hemorrhagic lesions of neocortex.’ Journal of Neuropathology and Experimental Neurology, 55, 758-773. Moody, D.M., Brown, W.R., Challa, V.R., Block, S.M. (1994) ‘Alkaline phosphatase histochemical staining in the study of germinal matrix hemorrhage and brain vascular morphology in a very-low-birth-weight neonate.’ Pediatric Research, 35, 424-430. Paneth, N., Rudelli, R., Kazam, E., Monte, W. (1994) Brain Damage in the Preterm Infant. Clinics in Developmental Medicine No. 131. London: Mac Keith Press. Pape, K.E., Wigglesworth, J.S. (1979) Haemorrhage, Ischaemia and the Perinatal Brain. Clinics in Developmental Medicine No. 69/70. London: Spastics International Medical Publications. Rypens F, Avni EF, Dussaussois L, David P, Vermeylen D, Van Bogaert P, Matos C (1994) Hyperechoic thickened ependyma: sonographic demonstration and significance in neonates. Pediatr Radiol 24:550–553. Schmidt, H. (1965) Untersuchungen zur Pathogenese und Ätiologie der geburtstraumatischen Hirnschädigungen Früh- und Reifgeborener. Jena: Gustav Fisher Verlag. in the search it may help to include the haemorrhagic nature of the lesion follow the arrow to the item that you want to explore for that region pop up message ——> references to the current item in alphabetical order suggest a correction some lesions or imaging alterations defy classification: other entities clues to antenatal onset within an item navigation is by buttons that highlight on hovering and a general navigator bar on the left of the screen, containing the link to references for the item CerebrUS choose the brain region that is abnormal in your images ——> ——> s u m m a r y the challenge A indicates that the lesion needs to correspond with an arterial template T return to the home page (top of the page) at any time to select another item pg when a lesion is clearly of antenatal onset, the differential diagnosis differs from acute intrapartum or neonatal events a summary of this item, by Sofia Spinedi, Bologna V indicates that the lesion may be related to a large vein display text The content is not based on products by artifical intelligence. Ultrasound and newborn brain injuryCerebrus stands for the cerebrum combined with cranial ultrasound (CUS). Ultrasound is the most used and most researched tool for imaging the newborn brain. This information targets clinicians with an active interest in newborn brain imaging, mainly performing cranial ultrasound themselves, including neuropaediatricians and paediatric radiologists. The descriptions may be useful for parents of any newborn infant with abnormal brain images, especially due to acquired injury. (Multi)focal brain injury and imagingThe site guides you through a collection of disease descriptions, mainly lesions. The aim is to provide a comprehensive definition of newborn brain changes observed with imaging. Although the anchors are ultrasound scans, magnetic resonance imaging is added for completion. Extensive attention is paid to lesions like haemorrhage, stroke and infection. For ischaemic stroke, arterial and venous anatomy are displayed in extenso. Vascular anatomy is documented with doppler ultrasound. Both preterm and term brain injury are described.Neuropathology (still the gold standard of newborn brain disease) is from the literature, personal observations and from dr Stefanie Brock at UZ Brussel. Item summaries are by Sofia Spinedi, neonatologist in AOU Bologna. Neonatologists and diagnostic imaging Clinical images are anonymised, collected during routine care in hospitals with a waiver for their use. Initial input is property of Paul Govaert, neonatology consultant in UZ Brussel, Belgium. The content is the result of collaboration between european neonatologists specialised in CUS, operating in group as eurUS.brain under the ESPR (European Society for Paediatric Research). Neuropathology (still the gold standard of newborn brain disease) is from the literature, personal observations and from dr Stefanie Brock at UZ Brussel. Every item has typical images (scans and graphics), contextual information and literature references. When graphics are adapted versions, the source is clearly indicated. The focus is on description of mechanisms behind newborn brain injury and their repercussion on imaging. When available long-term prognosis is added. The clinical neonatal background behind any item is provided in detail. Careful interpretation of the images should help to target diagnostic investigations, avoiding unnecessary excursions. For many items, suggestions for further research are added as appropriate. The robustness of the link between neonatal imaging and outcome remains questionable. CerebrUS tags: english: brain, ultrasound, newborn, haemorrhage, infarction french: sonographie, cerveau, nouveau-né, hémorragie, infarctus nederlands: hersenen, echografie, pasgeborene, bloeding, infarct go to navigator Mac OS X 2ÖATTRÜ,Ücom.apple.TextEncodingëcom.apple.provenanceöcom.apple.quarantineutf-8;134217984Â.Im0ÖWq/0081;00000000;;