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Ultrasound and Predicting Cerebral Palsy

Often cranial ultrasounds are used in determining whether or not the fetus has cerebral palsy but their ultimate success rates are not entirely conclusive in determining cerebral palsy due to a number of factors.  This does not mean that cranial ultrasounds are not important in monitoring your baby’s development health.  Rather, it may signify that multiple cranial ultrasounds might be necessary in making an informed diagnosis, or ruling anything out.

One measure of whether a fetus will go on to develop cerebral palsy is its likelihood of having PVL, or Periventricular Leukomalacia, which is the most common form of brain injury in premature babies.  Some 60-100% of babies with PVL go on to develop forms of cerebral palsy.  Unfortunately, PVL is not usually detectable until weeks after birth, and so cranial ultrasounds are usually not done until 4 to 8 weeks following delivery.  Cranial ultrasounds cannot penetrate bone and as such they can only be performed before the bones of the skull have fused together (pre-birth to some 8 weeks after delivery), or on adults with cerebral palsy shortly following surgery of the head.

Using a cranial ultrasound it is somewhat possible to determine whether or not the fetus has cysts, abnormalities, or holes in the brain characteristic of PVL.  Due to the changeability and size of these cysts, however, these determinations are very difficult to make and sometimes require repeated ultrasounds.  Occasionally the only sign of PVL in a fetus is a transitory flare, called an echodensity, which may signal that the fetus has PVE, fetal periventricular echodensity, which has shown to be a signifier in predicting future occurrences of PVL.  The brevity of these flares, however, makes scanning for them a difficult process using cranial ultrasounds. 

Another condition that can be screened for and may sometimes lead to cerebral palsy is IVH, or intraventricular hemorrhage, a bleeding of the baby’s brain that may occur just a few days after birth.  IVH happens more commonly in premature babies than in full-term babies.  Use of cranial ultrasounds to detect IVH is usually done within the first few days following delivery.  If PVL is suspected and there are no results on an initial ultrasound, additional cranial ultrasounds may have to be done at a later time (4-8 weeks post delivery) due to PVL’s propensity for not showing up immediately.

Sometimes babies with PVL or IVH may not develop cerebral palsy.  Because of this, constant monitoring and medical supervision, including additional cranial ultrasounds, may be necessary to either rule out cerebral palsy or make a diagnosis, often no earlier than 28 days post delivery.


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