Echodense spinal subarachnoid space in neonates with progressive ventricular dilatation: a marker of noncommunicating hydrocephalus

• Published in: American journal of roentgenology (1976) Vol. 171; no. 4; pp. 1119 - 1121
• Main Authors: Rudas, G, Almassy, Z, Papp, B, Varga, E, Meder, U, Taylor, GA
• Format: Journal Article
• Language: English
• Published: Leesburg, VA Am Roentgen Ray Soc 01.10.1998; American Roentgen Ray Society
• Subjects: Biological and medical sciences; Case-Control Studies; Cerebral Hemorrhage - diagnostic imaging; Cerebral Ventricles - diagnostic imaging; Female; Humans; Hydrocephalus - diagnostic imaging; Infant, Newborn; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Meningitis, Bacterial - diagnostic imaging; Nervous system; Subarachnoid Space - diagnostic imaging; Ultrasonic investigative techniques; Ultrasonography; Sonography; Human; Evaluation; Nervous system diseases; Spinal cord; Cerebral ventricle; Cerebral disorder; Progressive; Newborn diseases; Newborn; Dilatation; Subarachnoidal space; Central nervous system disease; Echography; Hydrocephaly
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/ajr.171.4.9763007

Our purpose was to evaluate the frequency and clinical significance of echogenic debris in the spinal subarachnoid space of neonates at risk for progressive ventricular dilatation. Spinal sonography was performed on 15 neonates with severe intracranial hemorrhage (n = 10) or bacterial meningitis (n = 5). Spinal sonography also was performed on 16 control neonates. Images were analyzed for the presence and location of echogeric debris within the thoracolumbar subarachnoid space. Lumbar punctures were performed on all 31 neonates, and CSF was analyzed for cell count and protein content. Ten of 15 neonates required ventricular drainage procedures. Progressive ventricular dilatation occurred in 11 of 15 neonates with intracranial hemorrhage or meningitis. Echogenic debris was present in the thoracolumbar subarachnoid space on spinal sonography in every neonate with progressive ventricular dilatation compared with none of the 16 control neonates (p < .0001 by chi-square analysis). In addition, the 11 neonates with echogenic subarachnoid space had significantly higher protein and RBC contents in the lumbar CSF (p < .04). Echogenic subarachnoid space revealed by sonography is associated with progressive ventricular dilatation after severe intracranial hemorrhage or bacterial meningitis and is caused by high protein and RBC contents in the subarachnoid space. This finding may be helpful in identifying neonates who will not benefit from serial lumbar punctures for treatment of hydrocephalus.