Hyperechoic lesions in the basal ganglia: An incidental sonographic finding in neonates and infants

Abstract

Cerebral ultrasound (US) imaging was performed as a screening procedure in approximately 3,600 neonates and infants over a period of 18 months. Hyperechoic lesions in the basal ganglia and thalamic region were detected incidentally in 15 of these patients. Clinical diagnoses included cytomegalovirus infection, asphyxia, rotavirus infection, prematurity, amniotic infection, dysmorphic stigmata, hyperbilirubinemia, congenital heart disease, and diabetic fetopathia. Lesions showed a single punctate (n = 5), multiple punctate (n = 8), or stripe-like pattern (n = 2), with no disease-specific distribution. Computed tomography performed in two of the 15 patients was normal. Lesions resolved within four to seven months in four of eleven cases who had follow-up studies, whereas echogenicities persisted in the remaining seven patients over a period of observation ranging between one to 15 months. Our results indicate that hyperechoic lesions in the basal ganglia and thalamic region may be associated with congenital infections and asphyxia, but could indicate some other unknown pathology. No correlation was found between the morphology of foci and both clinical diagnosis and results of follow-up studies.

Diffuse basal ganglia or thalamus hyperechogenicity in preterm infants

“…[1][2][3][4][5][6][7] BGTH can be detected as either diffuse hyperechogenicity 5 or linear or fine punctuate hyperechoic foci 4,6,7 in the region of the basal ganglia and the thalamus during routine neurosonogram in neonates.…”

“…1,2,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Basal ganglia hemorrhage results from periventricular hemorrhagic infarction or hemorrhagic necrosis. In preterm infants <28 weeks, diffuse caudate hemorrhage is difficult to differentiate from hemorrhage in the germinal matrix over the body of the caudate nucleus (grade I).…”

Association between Lenticulostriate Vasculopathy (LSV) and Neonatal Intraventricular Hemorrhage (IVH)

“…of our research team. 6 In these many instances, along with the congenital infections and the chromosomal abnormalities previously mentioned, a wide variety of perinatal conditions, including maternal-fetal alcohol exposure, 7 perinatal asphyxia, 8 twin-to-twin transfusion syndrome, 9 as well as other possible etiologies were thought to be related to the neurovasculopathy found in LSV. However, none of the previous studies, whether old or new, used regression modeling to control for possible confounding.…”

Isolated hyperechogenic foci in the fetal thalamus in early pregnancy

“…Linear echogenic structures representing echogenic blood vessels in the thalamus and basal ganglia have been described in the fetus 1 , and in newborn infants 2,3 . These linear or branching linear areas of echogenicity have been suggested to represent calcifications 4 , or vasculopathy 4,5 .…”