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6 - The central nervous system
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- By Hiten Mehta, University Hospitals Coventry and Warwickshire NHS Trust, Monica Epelman, University of Pennsylvania, Claire Miller, Birmingham Children's Hospital NHS Foundation Trust, Elaine M. Boyle, University of Leicester Department of Health Sciences
- Edited by Haresh Kirpalani, Monica Epelman, John Richard Mernagh, McMaster University, Ontario
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- Book:
- Imaging of the Newborn
- Published online:
- 05 March 2012
- Print publication:
- 24 November 2011, pp 106-138
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- Chapter
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Summary
Introduction
Neonatal imaging of the central nervous system has progressed rapidly in the last few years, although ultrasound (US) imaging remains the mainstay of bedside investigation. However, with the increased availability of magnetic resonance imaging (MRI), its potential utility is increasing. We highlight the relative usefulness of the imaging techniques available.
Principles of neuroimaging
Neuroinjury in the newborn
• In the preterm a range of potential effects stem from the physiologically large and vascular structure of the germinal matrix of the preterm; and may include the superadded effects of hypoxemia or ischemia. These extend from bleeds, to obstructive lesions of the ventricles, to periventricular leukomalacia. Details of the neuroanatomical effects that are usually seen clinically are discussed below under “A standard approach to assessing normal anatomy on US examinations.” Figure 6.1A–D shows diagrams that depict the anatomical location of the germinal matrix and its potential for damaging changes. These are coupled with corresponding ultrasound images and can be compared with those in Figure 6.2. Figure 6.3A–D shows the relevant comparable MRI images. Figure 6.4A–C shows relevant US anatomy in axial scans obtained via a transmastoid approach. Finally, Figure 6.5A–D shows US Doppler images obtained for the evaluation of the superior sagittal sinus with a corresponding MR venography image.