Trans-fontanellar Doppler sonography of the intracranial veins in infants. Part II--pathology

Colour coded Doppler sonography can be very helpful for the diagnosis of haemorrhagic infarction of the brain parenchyma, cerebral venous thrombosis and arterio-venous malformations of the brain. Intracranial haemorrhages into the brain parenchyma are caused by the compression of the subependymal and terminal veins which impede the venous drainage from the white matter. Haemorrhage of the basal ganglia is highly suspicious of cerebral venous thrombosis especially of the deep venous drainage. Unilateral occlusion of only one internal cerebral vein causes unilateral haemorrhage, bilateral thrombosis of both internal cerebral veins as well as occlusion of the great vein of Galens or the straight sinus causes bilateral haemorrhage of the basal ganglia as well as ventricular haemorrhage and haemorrhagic infarction of the white matter. The most common arterio-venous malformation of the brain is AV-malformation of Galens's vein. Sonographically, a pulsating cystic structure behind the 3rd ventricle can be shown. Colour coded Doppler sonography demonstrates the vascular nature of the cyst. Doppler sonography can show the feeding arteries, most frequently the posterior choroidal arteries and the venous drainage by the straight sinus.