Pediatric Sonoencephalography

Clinical sono-encephalography, although a relatively new technique, is rapidly gaining acceptance in hospital and specialist practice. No problem was involved in its introduction, as the method is self-evidently suitable for the diagnosis of acute and chronic intracranial lesions. As an auxiliary exami nation it is, within its limitations, almost ideal: it requires no large invest ment in apparatus, it is rapidly done, the patient suffers no discomfort, and there is no risk of complications. In the hands of an experienced examiner, who has a solid grounding in neurological theory and practice to enable him . to interpret his findings, it yields important and reliable information. The use of this method in children requires special knowledge, covering the age of the child, the technique of examination, the range of normality and the interpretation of the pathological findings from the neuropediatric point of view. These special features of pediatric sono-encephalography are seldom discussed in the literature, wide as it is. This monograph is designed to bridge the gap. The book is based on the author's extensive experience acquired over a number of years in the neuropediatric department of the University Children's Hospital Heidelberg. Wisely used, pediatric sono-encephalography should provide a useful tool, not only for experts in highly specialized hospital de partments, but also for pediatricians, neuropediatricians, child psychiatrists, neurologists and neurosurgeons engaged in more routine clinical work. Heidelberg, February 1971 HORST BICKEL Preface Neuropediatrics has experienced enormous advances within recent years.

Clinical sono-encephalography, although a relatively new technique, is rapidly gaining acceptance in hospital and specialist practice.

One: General Sonoencephalography.- I General Physical Properties of Sound in Liquids and Gases.- A. Classification of Sounds.- B. Physical Characteristics of Ultrasound.- C. Laws of Reflection and Refraction.- D. Conditions Favorable to Reflection.- E. Diffraction.- F. Sound Scattering and Absorption (Sound Attenuation).- II Technical Considerations of the Ultrasonic Impulse Apparatus.- A. Construction of the A-scope Apparatus.- 1. Transmitter.- 2. Sound Receiver.- 3.-5. The Screen Image (Synchronization Unit, Indicator Gauge, and Sweep Generator).- B. Linear-Scanning.- C.-E. Arc-, Sector- and Compound-Scanning.- III Examination of Pediatric Patient.- A. Examination Procedure with Patient in the Supine Position.- B. Examination Procedure with Patient in the Sitting Position.- IV Terminology.- V The Normal Sonoencephalogram (SEG).- A. Origin of SEG Reflections.- B. Initial Echo (IE) and End Echo (EE).- Thickness of the Osseous Cranium.- C. Midline Echo (ME).- D. Demonstrating the Third Ventricle.- Third Ventricular Reflections.- E. Lateral Ventricular Echoes and Determination of the Ventricular Index.- Lateral Ventricular Index (LVI).- F. Lateral Echoes (Temporal Horn Echoes, Insula Echoes).- 1. Brain Mantle Index (BMI).- 2. Comparison of Capability of Measuring LVI and BMI in Various Age Groups.- VI The Abnormal Sonoencephalogram.- A. Midline Echo Shift.- B. Recognition and Identification of the Midline Echo.- C. Demonstrating the Dilated Ventricular System.- D. Calculation of the Pathological Lateral Ventricular Index.- E. Measurement of the Abnormal Third Ventricle.- F. Determination of Abnormally Enlarged Lateral Ventricles by Exhibition and Measurement of the Outer Wall of the Temporal Horn-Brain Mantle Index (BMI).- Two: Special Sonoencephalography.- VII Brain Trauma.- A. Sonoencephalographic Examination of Children with Post-Traumatic Intracranial Hematomas and Hygromas.- Brain Concussion and Contusion.- B. Intracranial Hematomas.- 1. Epidural Hematoma.- Hematoma Echoes.- 2. Acute Subdural Hematoma.- 3. Chronic Subdural Hematoma.- 4. Subdural Hygroma (Pachymeningosis serosa).- 5. Intracerebral Hematoma.- Illustrative Cases.- VIII Sonoencephalographic Examination of Childhood Hydrocephalus.- A. Examination of 188 Children with Clinically Suspected Internal Hydrocephalus.- IX Sonoencephalographic Examination in Intracranial Space-Occupying Lesions.- A. Supratentorial Space-Occupying Lesions.- B. Infratentorial Space-Occupying Lesions.- X Congenital and Developmental Defects and Brain Damage in Early Childhood.- A. Sonoencephalographic Findings.- B. Prenatally Determined Brain Damage as Sometimes Exhibited in Phenylketonuria.- XI Sonoencephalographic Examination in Various Convulsive Disorders.- XII Reliability of the Sonoencephalogram in the Diagnosis of Childhood Hydrocephalus.- A. Comparison of SEG Results with other Clinical Data.- B. Comparison of SEG and PEG Measurements of the Third Ventricle.- C. Comparison of Sonoencephalographic and Pneumoencephalography Values of the Lateral Ventricle.- 1. Calculation of the SEG Lateral Ventricular Index (LVI).- 2. Evaluation of PEGs.- 3. Comparison of PEG and SEG Lateral Ventricular Index.- D. Comparison of the Roentgenological and Sonoencephalographical Lateral Ventricular Index.- E. The Value of SEG Follow-up Studies in Evaluation of Hydrocephalus.- Illustrative Cases.- XIII Sources of Error and Particulars.- A. Erroneous Measurement in Determining the Midline Echo.- B. Sources of Error in Measuring the Width of the Third Ventricle.- C. Sources of Error in Determining the Lateral Ventricular and Brain Mantle Index.- Three: The Combined EEG and SEG.- XIV The Combined Electroencephalographic and Sonoencephalographic Examination.- A. Introduction.- B. Sonoencephalographic Examination Procedure.- 1. Position of Diencephalic Midline.- 2. Determination of Lateral Ventricular Expanse.- 3. Measuring Third Ventricular Width.- C. Subject Material.- D. EEG Results.- E. SEG Results.- F. Comparison of SEG and EEG Findings.- Illustrative Cases.- References.