Cranial Ultrasound Imaging Research Articles

Ultrasound-Based Phenotyping of Lateral Ventricles to Predict Hydrocephalus Outcome in Premature Neonates.

Prediction of post-hemorrhagic hydrocephalus (PHH) outcome-i.e., whether it requires intervention or not-in premature neonates using cranial ultrasound (CUS) images is challenging. In this paper, we present a novel fully-automatic method to perform phenotyping of the brain lateral ventricles and predict PHH outcome from CUS. Our method consists of two parts: ventricle quantification followed by prediction of PHH outcome. First, cranial bounding box and brain interhemispheric fissure are detected to determine the anatomical position of ventricles and correct the cranium rotation. Then, lateral ventricles are extracted using a new deep learning-based method by incorporating the convolutional neural network into a probabilistic atlas-based weighted loss function and an image-specific adaption. PHH outcome is predicted using a support vector machine classifier trained using ventricular morphological phenotypes and clinical information. Experiments demonstrated that our method achieves accurate ventricle segmentation results with an average Dice similarity coefficient of 0.86, as well as very good PHH outcome prediction with accuracy of 0.91. Automatic CUS-based ventricular phenotyping in premature newborns could objectively and accurately predict the progression to severe PHH. Early prediction of severe PHH development in premature newborns could potentially advance criteria for diagnosis and offer an opportunity for early interventions to improve outcome.

Enlarged subarachnoid space on cranial ultrasound in preterm infants: Neurodevelopmental implication

The role of enlarged subarachnoid space (ESS) in preterm infants has not been described in concrete. We aimed to evaluate whether ESS should be considered a risk factor potentially associated with adverse neurodevelopmental outcomes in prematurity. Electronic medical records of 197 preterm infants (median 32.1 weeks' gestation) including cranial ultrasound (cUS) images, head circumferences, and Korean Developmental Screening Tests for Infants and Children (K-DST) results at 18–24 months corrected age were reviewed. The clinical characteristics and K-DST results were compared in infants with and without ESS (sinocortical width > 3.5 mm). A multivariable logistic regression analysis was performed to identify potential risk factors associated with positive K-DST results. At a median corrected age of 39.0 weeks, 81/197 (41.1%) infants presented ESS. A significantly greater percent of infants in the ESS group screened positive on the K-DST than in the no ESS group (27.2% vs 12.1%, p = 0.007). Within the ESS group, micro-/macrocephaly at term-equivalent age was not different with regard to the K-DST results. From the multivariable logistic regression analysis, gestational age (p = 0.016, OR = 0.855, 95% CI = 0.753–0.971) and ESS (p = 0.019, OR = 1.310, 95% CI = 1.046–1.641) were two significant risk factors associated with positive K-DST results. ESS identified on cUS at term-equivalent age in preterm infants is associated with possible developmental delays. Macrocephaly at term-equivalent age does not guarantee a benign prognosis. Future studies are required to verify ESS as a potential marker for neurodevelopmental delay in preterm infants.

Blood pressure extremes and severe IVH in preterm infants.

BackgroundThe optimal upper and lower limits of blood pressure in preterm infants are not known. Exceeding these thresholds may contribute to intraventricular hemorrhage (IVH).MethodsPreterm infants born ≤30 weeks GA were identified. Infants had continuous measurement of mean arterial blood pressure (MABP) for 7d and cranial ultrasound imaging. IVH was classified as severe IVH (grade 3/4), no severe IVH (no IVH; grade 1/2), or no IVH.Mean±SEM MABP values from hours 1–168 were calculated and sorted into bins 2 mmHg wide. The normalized proportion of each recording spent in each bin was then calculated. Candidate limits were identified by comparison of MABP distribution in those with severe IVH vs. those without severe IVH.Results85 million measurements were made from 157 infants. Mean EGA was 25.2 weeks; mean BW was 749g; 65/157 female; inotrope use in 59/157; grade 3/4 IVH in 29/157. Infants with severe IVH spent significantly more time with extreme MABP measurements (<23 mmHg or >46mmHg) compared to those without severe IVH (12% vs. 8% of recording, p=0.02).ConclusionInfants who developed severe IVH had substantially more unstable MABP and spent a significantly greater period of time with MABP outside of the optimal range.

Multicystic encephalomalacia and gastrointestinal injury following single fetal death in first trimester and subsequent fetofetal transfusion syndrome in a monochorionic triplet pregnancy: a case report

BackgroundMonochorionic multifetal pregnancies are at increased risk of adverse perinatal outcome because of placental vascular anastomoses. We present a case of multicystic encephalomalacia and gastrointestinal injury in two surviving fetuses following single fetal death in first trimester and subsequent fetofetal transfusion syndrome in a monochorionic triplet pregnancy.Case presentationA 31-year-old nulliparous woman had a spontaneous monochorionic triamniotic triplet pregnancy. Three live fetuses with single placenta were seen at 8-week ultrasound scan. One fetus demised at 11 weeks and 3 days of gestation. Dilated echogenic bowel and ascites were found in one surviving fetus at 23 weeks of gestation. At 28 weeks of gestation, the pregnancy was complicated by fetofetal transfusion syndrome in which discordant amniotic fluid volumes were found. Two days later, emergency Caesarean section was performed because of worsening of fetal Doppler and biophysical profile. One baby was found to have jejunal atresia requiring surgery at 4 days old. He had periventricular leukomalacia and intracranial haemorrhage, but subsequent normal neurological development. Another baby had gastric perforation requiring surgery at 2 days old. He was confirmed to have multicystic encephalomalacia by cranial ultrasound and magnetic resonance imaging. He suffered from developmental delay, epilepsy and cerebral palsy.ConclusionThis case alerts the obstetricians the possible hypoxic-ischemic injury to the survivors of monochorionic triplet pregnancy after the co-triplet death in the first trimester and fetofetal transfusion syndrome. Antenatal assessment and postnatal follow-up are important for these high-risk multiple pregnancies.

Early Prediction of Periventricular Leukomalacia Using Quantitative Texture Analysis of Serial Cranial Ultrasound Scans in Very Preterm Infants

We compared texture parameters of serial cranial ultrasound (cUS) images of periventricular leukomalacia (PVL) and normal periventricular echogenicity (PVE) in very preterm infants and evaluated the early predictive values of texture analysis (TA) for PVL. Ten individuals with PVL and 10 control individuals with PVE assessed with an initial cUS within 1 wk of birth and follow-up cUS at 2–3 and 4–6 wk of life were included. TA was performed on the region of interest of PVE at the parieto-occipital area on serial cUS. Opposite changes in variance were obtained between the first two cUS sessions in both groups (p = 0.017 in PVL and p = 0.005 in PVE). The variance-to-mean ratio (VMR) between the second and first cUS sessions differed (p = 0.016) and reliably stratified the groups (area under the receiver operating characteristic curve: 0.820, 95% confidence interval: 0.587–1.000, sensitivity: 100%, specificity: 60%). TA of serial cUS helps to predict PVL within 3 wk of life.

Brain imaging can predict neurodevelopmental outcome of Group B streptococcal meningitis in neonates.

The association between cranial ultrasound (CUS) or magnetic resonance imaging (MRI) lesions and neonatal Group B streptococcal (GBS) meningitis outcome has not been studied in detail. This retrospective study assessed CUS, cranial MRI and neurodevelopmental outcome in 50 neonates with GBS meningitis admitted to three neonatal intensive care units in the Netherlands between 1992 and 2014. Death, cognitive outcome and motor outcome below -1 SD were considered as adverse outcomes. CUS was available in all and MRIs in 31 infants (62%) with 28 CUS (56%) and 27 MRIs (87%) being abnormal. MRI lesions were multifocal (n=10, 37%), bilateral (n=22; 82%) and extensive (n=11; 41%). A total of 10 died in the neonatal period. Median age at assessment was 24months. Among survivors, abnormal cognitive outcome and motor outcome were seen in 23 and 20 patients, respectively. Abnormal CUS [odds ratio (OR) 5.3, p=0.017], extensive bilateral deep grey lesions (OR 6.7, p=0.035) and white matter lesions (OR 14.0, p=0.039) correlated with abnormal motor outcome. Extensive bilateral deep grey matter lesions correlated with abnormal cognitive outcome (OR 8.1, p=0.029). Abnormal CUS and the most severely affected MRIs were associated with poor neurodevelopmental outcome in neonatal GBS meningitis.

Neonatal HCMV-related polymicrogyria in seroimmune women: What is the optimal pregnancy management?

BackgroundHuman cytomegalovirus (HCMV) infection is the most common congenital infection in developed countries. Recent studies highlighted similar percentages of symptoms in HCMV congenitally-infected infants following either primary or non-primary maternal infections. ObjectivesTo highlight correlation between neonatal brain abnormalities, detected by ultrasounds and magnetic resonance image in HCMV congenitally-infected infants, and maternal virological parameters during pregnancy, especially in seroimmune mothers. Study designWe considered the 36 HCMV congenitally-infected infants (26 asymptomatic and 10 symptomatic) referred to our center over 4 consecutive years. Maternal serologic data during pregnancy were available for all cases. Neonatal cranial ultrasound and magnetic resonance images were related to maternal virological findings during pregnancy. ResultsPolymicrogyria was observed in 6/10 (60.0%) symptomatic and 0/26 (0%) asymptomatic newborns (p < 0.001). The 6 infants with polymicrogyria were all born to mothers who were HCMV IgG reactive with negative specific IgM, in the first trimester of pregnancy (range: 8–14 weeks). For these six women, pre-conceptional HCMV serologic information were absent and they all were considered immune for HCMV during pregnancy, therefore no further serologic investigation or specific educational and hygienic information were recommended during gestation. ConclusionThese data highlight the elevated frequency of polymicrogyria in HCMV congenitally-infected infants born to mothers defined as seroimmune in the early stage of pregnancy and having no pre-existing serologic information. The paper stresses the potential utility of pre-conceptional screening to define maternal infection reliably (primary vs non-primary), and allow evidence-based counseling in women with positive serology, suggesting also preventive hygienic measures during pregnancy.

Cranial ultrasound and neurophysiological testing to predict neurological outcome in infants born very preterm.

Infants born preterm are at risk of cerebral palsy (CP) and motor or cognitive developmental delay. For clinicians, it is essential to know the relative predictive accuracy of the most commonly used neuroimaging and neurophysiological tests for the early prediction of adverse neurodevelopmental outcome. The aim of this study was to compare the accuracy of these tests in survivors of a population of infants born very preterm. A retrospective cohort study was performed in 163 children born before 32 weeks gestational age. We compared the accuracy in predicting adverse neurodevelopmental outcome at the age of 2 years 6 months of early and late cranial ultrasound (CUS), magnetic resonance imaging, somatosensory evoked potentials after stimulation of the posterior tibial nerve, and electroencephalography by calculating positive and negative likelihood ratios. An abnormal early CUS is the best predictor of the presence of CP (positive likelihood ratio 6.09), motor developmental delay (positive likelihood ratio 3.11), and cognitive developmental delay (positive likelihood ratio 5.66). Overall, negative likelihood ratios were poor, ranging between 0.49 and 0.98, meaning that a normal test result had only minimal influence on the probability of adverse neurological outcome. None of the diagnostic tests had a good performance in predicting future neurodevelopmental problems in infants born preterm. A normal test result provided very little clinically useful information. An abnormal early cranial ultrasound (positive test result) is the best predictor of adverse neurodevelopmental outcome. All negative results have poor predictive value of future neurodevelopmental problems.

Automatic Segmentation of Neonatal Ventricles from Cranial Ultrasound for Prediction of Intraventricular Hemorrhage Outcome.

Intraventricular hemorrhage (IVH) followed by post hemorrhagic hydrocephalus (PHH) in premature neonates is one of the recognized reasons of brain injury in newborns. Cranial ultrasound (CUS) is a noninvasive imaging tool that has been used widely to diagnose and monitor neonates with IVH. In our previous work, we showed the potential of quantitative morphological analysis of lateral ventricles from early CUS to predict the PHH outcome in neonates with IVH. In this paper, we first present a new automatic method for ventricle segmentation in 2D CUS images. We detect the brain bounding box and brain mid-line to estimate the anatomical positions of ventricles and correct the brain rotation. The ventricles are segmented using a combination of fuzzy c-means, phase congruency, and active contour algorithms. Finally, we compare this fully automated approach with our previous work for the prediction of the outcome of PHH on a set of 2D CUS images taken from 60 premature neonates with different IVH grades. Experimental results showed that our method could segment ventricles with an average Dice similarity coefficient of 0.8 ± 0.12. In addition, our fully automated method could predict the outcome of PHH based on the extracted ventricle regions with similar accuracy to our previous semi-automated approach (83% vs. 84%, respectively, p-value = 0.8). This method has the potential to standardize the evaluation of CUS images and can be a helpful clinical tool for early monitoring and treatment of IVH and PHH.

Circulating biomarkers in extremely preterm infants associated with ultrasound indicators of brain damage.

To assess to what extent the blood concentrations of proteins with neurotrophic and angiogenic properties measured during the first postnatal month convey information about the risk of sonographically-identified brain damage among very preterm newborns. Study participants were 1219 children who had a cranial ultrasound scan during their stay in the intensive care nursery and blood specimens collected on 2 separate days at least a week apart during the first postnatal month. Concentrations of selected proteins in blood spots were measured with electrochemiluminescence or with a multiplex immunobead assay and the risks of cranial ultrasound images associated with top-quartile concentrations were assessed. High concentrations of multiple inflammation-related proteins during the first 2 postnatal weeks were associated with increased risk of ventriculomegaly, while high concentrations of just 3 inflammation-related proteins were associated with increased risk of an echolucent/hypoechoic lesion (IL-6, IL-8, ICAM-1), especially on day 7. Concomitant high concentrations of IL6R and bFGF appeared to modulate the increased risks of ventriculomegaly and an echolucent lesion associated with inflammation. More commonly high concentrations of putative protectors/repair-enhancers did not appear to diminish these increased risks. Our findings provide support for the hypothesis that endogenous proteins are capable of either protecting the brain against damage and/or enhancing repair of damage.

Neonatal Central Nervous System Infection

AbstractIn this review article, neuroimaging features of common bacterial, viral, fungal, and parasitic infections of the pediatric central nervous system (CNS) are discussed. Imaging modalities used by pediatric neuroradiologists include cranial ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). After a brief discussion of the clinical presentation of each disease entity, imaging strategies and findings are reviewed. The role of advanced neuroimaging techniques is discussed wherever appropriate.

Growth and neurodevelopment outcome of NICUgraduates till 1 year at a tertiary care centre in eastern India and identification of the clinical and electrophysiological predictors of adverse developmental outcome

Background: Despite serious neonatal morbidity, the neurodevelopmental outcome of NICU (Neonatal Intensive Care Unit) graduates is often reasonably good. Infants with neurodevelopmental abnormality need to start therapy early, and hence, they should be detected as soon as possible. Therefore we need well designed follow-up services. Objectives: To study the outcome of growth and development till one year of age of NICU graduates from a tertiary care centre in eastern India. Design and setting: A prospective neurodevelopmental follow-up study on graduates from the Calcutta National Medical College and Hospital NICU. Methodology: We selected a cohort of 177 consecutive NICU graduates according to high-risk criteria and followed them up at the high risk clinic of Paediatrics department up to 1 year of age on a predetermined schedule. Growth monitoring (weight, length, head circumference measurements), neurologic examination by Amiel-Tison method, developmental assessment using Denver Development Screening Test (DDST) as screening tool and Developmental Assessment Scale for Indian Infants (DASII) as a definitive test, neuroimaging (cranial ultrasound or magnetic resonance imaging of brain) and electrophysiological investigations visual evoked potential (VEP), brainstem auditory evoked response (BAER), and electroencephalogram (EEG) were done. Early stimulation and physiotherapy were advised as per need. Ongoing illnesses were identified and treated. Results: Out of 177 consecutive NICU graduates enrolled in the study, 155 were followed up to 1 year of age. There were no statistically significant difference in the occurrence of growth failure, and neurodevelopmental delay between term and preterm and between appropriate for gestational age (AGA) and small for gestational age (SGA) infants. However growth failure was significantly higher among infants with neurodevelopmental delay. Conclusion: Persistence of abnormalities in tone, BAER, EEG & neuroimaging strongly predicted adverse neurodevelopmental outcome. Recurrent respiratory tract infection was found to be the most common morbidity among NICU graduates followed by seizure disorder.

Neonatal Hypoxic-ischemic Encephalopathy: A Radiological Review.

Neonatal hypoxic-ischemic encephalopathy (HIE) is a devastating condition that may result in death or severe neurologic deficits in children. Neuroimaging with cranial ultrasound (US), computed tomography and magnetic resonance imaging are valuable tools in the workup of patients with HIE. The pattern of brain injury depends on the severity and duration of hypoxia and degree of brain maturation. Mild to moderate HI injury results in periventricular leukomalacia and germinal matrix bleed in preterm neonates, and parasagittal watershed infarcts in full-term neonates. Severe HI injury involves deep gray matter in both term and preterm infants. Treatment of HIE is largely supportive. The current article reviews the etiopathophysiology and clinical manifestations of HIE, role of imaging in the evaluation of the condition, patterns of brain injury in term and preterm neonates, the treatment and the prognosis.

Neuroimaging practices in very low birth weight neonates

Objective: Cranial ultrasound (CUS) and magnetic resonance imaging (MRI) are used to detect brain injury in very low birth weight (VLBW) neonates. Our study attempts to determine the abnormalities found on physician-selected MRI compared to CUS findings and whether any infant characteristic can predict new MRI-detected abnormalities. Methods: Radiology reports of neonates admitted between 2010 and 2014, with birth weights between 501 and 1500 g, were retrospectively reviewed. We excluded infants who died or were transferred and those with a major congenital malformation. Reports were individually reviewed for pertinent positive findings. In addition, various perinatal and maternal characteristics were collected from the electronic medical record. Receipt of MRI and MRI findings were compared with respect to perinatal and maternal characteristics. Results: Out of the 605 VLBW neonates evaluated for the study, 94 infants received MRI. Among the infants with MRI, 43 (46%) had significant findings and 17 (18%) had new significant findings not found by CUS. The MRI did not detect any new intraventricular hemorrhage (IVH) and ventriculomegaly or cystic periventricular leukomalacia (PVL). Infants who had lower gestational age, longer length of stay, lower birth weight, and who had severe IVH, PVL, severe retinopathy of prematurity, or bronchopulmonary dysplasia had significantly higher odds of receiving MRI. Findings from MRI (exclusive or nonexclusive) were not significantly associated with any perinatal characteristic. Conclusions: Although routine use cannot be recommended, physician-selected MRI has a relatively high detection rate of exclusive findings and can potentially increase detection rate.

Guidelines: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Diagnosis of Patients With Positional Plagiocephaly: The Role of Imaging.

No evidence-based guidelines exist for the imaging of patients with positional plagiocephaly. The objective of this systematic review and evidence-based guideline is to answer the question, Is imaging necessary for infants with positional plagiocephaly to make a diagnosis? The National Library of Medicine Medline database and the Cochrane Library were queried with the use of MeSH headings and key words relevant to imaging as a means to diagnose plagiocephaly. Abstracts were reviewed, and an evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). A total of 42 full-text articles were selected for review. Of these, 10 were eliminated; thus, 32 full-text were manuscripts selected. There was no Class I evidence, but 2 Class II and 30 Class III studies were included. Three-dimensional cranial topographical imaging, ultrasound, skull x-rays, computed tomography, and magnetic resonance imaging were investigated. Clinical examination is most often sufficient to diagnose plagiocephaly (quality, Class III; strength, Level III). Within the limits of this systematic review, the evidence suggests that imaging is rarely necessary and should be reserved for cases in which the clinical examination is equivocal. Many of the imaging studies were not designed to address the diagnostic utility of the imaging modality, and authors were actually assessing the utility of the imaging in longitudinal follow-up, not initial diagnosis. For this reason, some of the studies reviewed were downgraded in Level of Evidence. When needed, 3-dimensional cranial topographical photo, skull x-rays, or ultrasound imaging is almost always sufficient for definitive diagnosis. Computed tomography scanning should not be used to diagnose plagiocephaly, but it may be necessary to rule out craniosynostosis. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_2.

Congenital Intracranial Space Occupying Lesion: A Case Report

Congenital intracranial space occupying lesion (SOL) is extremely rare. We present a case of congenital intracranial space occupying lesion diagnosed during ultrasound at 33 weeks gestation. Following delivery by caesarean section at 34 weeks, cranial ultrasound and magnetic resonance imaging (MRI) of the brain suggested primitive neuroectodermal tumour. Parents declined surgery and baby subsequently passed away on day 11 of life. Prognosis of congenital SOL is generally poor. Accurate antenatal diagnosis is crucial to help in counselling and discussion of delivery options or termination of pregnancy.

Quantitative 3D and 2D Head Ultrasound to Determine Thresholds for Intervention In Preterm Neonates with Posthemorrhagic Ventricular Dilation

Abstract BACKGROUND: Preterm neonates with intraventricular hemorrhage (IVH) often acquire post hemorrhagic ventricle dilation (PHVD), which, when severe, can lead to neurological impairment. Cranial 2D ultrasound (US) images are used for the diagnosis and monitoring of PHVD; however, there is no consensus on the use of 2D US images to guide treatment. This can lead to delays in interventions, and the potential for brain injury. We have developed a 3D US system that has been shown to accurately detect changes ventricle volumes (VV). OBJECTIVES: We investigate the utility of using 3D and 2D US measurements to determine thresholds for treatment of neonates with PHVD and to predict the need for further treatments. DESIGN/METHODS: Neonates were imaged twice weekly in accordance to a protocol approved by the research ethics board. 3D US images were manually segmented to obtain VV. 2D measurements included ventricle index, anterior horn widths, third ventricle width, and largest thalamo-occipital distance. The rate of change for each measurement was calculated. Decisions to perform ventricular taps (VTs) to relieve intracranial pressure were made independently by neurosurgeons who were blinded to study images. Receiver operator curves (ROC) were generated using the sensitivity and specificity of the rates of change of sonographic parameters in predicting the need for V T. For each parameter optimal threshold for intervention was estimated by the area under ROC; and positive and negative predictive values (PPV, NPV) were calculated. Additionally, we investigated whether US measurements predicted the need for multiple interventions. RESULTS: 23 neonates with PHVD were enrolled, 8 required interventions. The best predictor to determine initial intervention was the rate of change in VV when a threshold of &amp;gt;2.04 cm3/day was used within the first three weeks of life (NPV and PPV of 1) and, this measurement was able to determine if then a patient would require further interventions when a threshold of -0.04 cm3/day was used looking at imaging time points after the first intervention (NPV and PPV of 1). 2D measurements were less sensitive and/or less specific (sensitivity of 88-57%, specificity of 100-79%, PPV of 0.88-0.57 and NPV of 0.93-0.79). CONCLUSION: 3D US VV can predict the requirement for interven-tional ventricular tap in neonates with IVH, and can identify patients that have resolving PHVD following initial intervention, with higher sensitivity and specificity than 2D US measurements. These findings show promise for early classification of neonates using 3D US for prediction of interven-tional therapy, potentiallyaiding in timely management of these patients.

JoVE - Year in Review: 2015

In January 2015, JoVE Developmental Biology became the newest addition to the JoVE family, and featured a live-imaging protocol for visualizing the developing Drosophila eye. In February, JoVE Medicine showed state-of-the-art cranial ultrasound imaging in neonates. Advances in this technique have improved its diagnostic value, allowing timely therapeutic intervention. In March, JoVE Environment featured dendroecology, the science of using tree rings to study ecological effects of specific environmental factors. In April, JoVE Biology examined a mode of bacterial motility called swarming with a two-phase swarm assay. that can be used to study various aspects of bacterial growth. In May, JoVE Chemistry described the self-assembly of single-stranded DNA tiles into complex 2D shapes. This demonstrated the principles of DNA tiling as an approach for making programmable nanostructures. June 2015 marked the release of JoVE's 100th issue, and in JoVE Behavior, we featured protocols for assessing cognition, including a method of quantifying learning in young infants by tracking leg movements. In July, JoVE Medicine presented a method for measuring halitosis in dogs by taking breath samples, and performing gas chromatography. This assay could be used in trials of dog food formulated to fight bad breath in our canine companions. In August, JoVE Bioengineering contained a protocol for bioengineering kidney tissues. Kidneys are decellularized by perfusion, and repopulated with human renal cells, This promising technology can lead to kidney grafts made from a patient's own cells. In September, JoVE Environment examined herbicide resistance, which threatens commercial crop production. An excised leaf assay determines the rates of herbicide metabolism, which is useful for studying the metabolic basis of resistance. In October, JoVE Neuroscience featured a method for interfacing 3D neuronal cultures to micro-electrode arrays. The complex 3D assemblies closely approximate in vivo neural networks. November's edition of JoVE Behavior showcased the natural human ability to acquire new motor skills, which is central in a structured rehabilitation program for amputees as they learn how to use multifunctional prosthetics. In December, JoVE Immunology & Infection prepared us for the impending flu season with an easy protocol for sampling influenza in pigs. Because swine are important hosts for flu viruses, this method helps to monitor virus evolution and currently circulating strains. This Year in Review was just a sampling of more than 900 video-articles that JoVE published in 2015. Browse the JoVE archives for thousands of other videos, and come back each week to see brand-new material in JoVE: The Journal of Visualized Experiments.

Neonatal parechovirus leucoencephalitis- radiological pattern mimicking hypoxic-ischemic encephalopathy

AimOur objective is to study the MR imaging pattern in neonatal parechoviral leucoencephalitis, a rare cause of neonatal white matter abnormality and to differentiate it from hypoxic-ischemic encephalopathy which is the commonest cause of white matter change in neonates. MethodWe evaluated 25 neonates who presented with features of encephalopathy. Cranial ultrasound and MR imaging was done in all the cases. The pattern of white matter abnormality was analyzed in all cases. ResultsNeonatal leucoencephalitis caused by HPeV has a distinctive clinical presentation and has predilection for the white matter, causing diffusion restricting signal intensity changes involving the periventricular and subcortical white matter, in particular the frontal white matter, also the corpus callosum, internal capsule, external capsule and pyramidal tracts of the supratentorial brain and cerebral peduncle with relative sparing of occipital white matter, thalamus, basal ganglia and the infratentorial regions. Follow up imaging shows disappearance of the lesion without white matter loss. Whereas mild to moderate hypoxic-ischemic injury in a full-term neonate causes lesions in the watershed areas, and subcortical white matter predominantly involving the parietooccipital region and perirolandic region. Thalamus, brainstem, cerebellum, and deep gray matter structures are involved depending on the severity. ConclusionWhite matter changes in the neonatal period are commonly associated with hypoxic-ischemic injuries and metabolic causes, less frequently, infection like parechovirus leucoencephalitis. HPeV infection must be considered in infants with specific pattern of white matter change but no convincing history of a perinatal hypoxic-ischemic insult, thus differentiating it from HIE.

Perinatal brain damage: The term infant

Perinatal brain injury at term is common and often manifests with neonatal encephalopathy including seizures. The most common aetiologies are hypoxic–ischaemic encephalopathy, intracranial haemorrhage and neonatal stroke. Besides clinical and biochemical assessment the diagnostic evaluation rely mostly on EEG and neuroimaging including cranial ultrasound and magnetic resonance imaging. The mechanisms underlying hypoxic–ischaemic brain injury are only partly understood but include excitotoxicity, mitochondrial perturbation, necrosis/apoptosis and inflammation. Neuroprotective treatment of newborns suffering from hypoxic–ischaemic encephalopathy with hypothermia has proven effective and has been introduced as a clinical routine. Ongoing studies are exploring various add-on therapies including erythropoietin, xenon, topiramate, melatonin and stem cells.