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Severe Juvenile Hypothyroidism
Joseph Junewick, MD FACR
over 7 years ago
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Status Marmoratus

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Vascular
Created: over 9 years ago
Updated: over 9 years ago
Tags: PEDS
Modality/Study Types: US
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Term newborn with neurological depression and history of perinatal distress.

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Status Marmoratus


US – Hyperechoic thalami and basal ganglia with effacement of the cerebrospinal fluid spaces.


In the newborn several patterns of hypoxic-ischemic injury may be evident. Selective neuronal injury of the striatum initially appears normal on sonography but becomes hyperechoic over several days related to edema, gliosis or calcification. Parasagittal watershed ischemia occurs along the intersection of the anterior and middle and/or middle and posterior cerebral artery related to hypotension, hypoxia or glucose deprivation; parasagittal watershed ischemia is often associated with selective neuronal injury of the striatum. Ischemic perinatal stroke is related to arterial or venous thrombosis and is manifest by discreet hyperechoic foci, progressive distortion of junctional differentiation and eventual hyperemia on Doppler. Diffuse hypoxic-ischemic injury results in diffuse parenchymal swelling with effacement of the cerebrospinal fluid containing spaces and loss of junctional differentiation.


Heinz ER, Provenzale JM. Imaging findings in neonatal hypoxia: a practical review. AJR (2009); 192:41-47.

Chao CP, Zaleski CG, Patton AC. Neonatal hypoxic-ischemic encephalopathy: multimodality imaging findings. Radiographics (2006); 26:S159-172.

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