case_images: PMC11362048_01
case_images: cUS and MRI findings of case 1. (A) cUS coronal view, showing a right-sided echogenic lesion temporo-occipital with midline shift to the left. (B) MRI T2-weighted sequence, axial view, and (C) MRI susceptibility-weighted imaging sequence, coronal view, showing an intra-axial hemorrhage in the right temporo-occipital region with an extra-axial component in the frontotemporal region, with a maximal thickness of 32 mm. This causes a mass effect on the right temporal lobe with midline shift of 5 mm to the left. (D) cUS coronal view, after surgical intervention.
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case_images: F1
case_images: Cranial ultrasound (cUS) revealed a large right-sided echogenic temporo-occipital lesion with a mild midline shift to the left (Figure 1A). There was also intra-axial blood in the temporo-occipital region and an intraventricular hemorrhage on the right side, with a more limited extra-axial hemorrhage in the left temporal region (Figures 1B,C). Serial cUS over the following days showed a further decrease in the size of the hemorrhage and reduction of the midline shift, without signs of rebleeding (Figure 1D).
case_images: Timeline of the neurological course of cases 1-3. In all cases, the seizures ceased after neurosurgical intervention. cUS, cerebral ultrasound; MRI, magnetic resonance imaging.
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case_images: F2
case_images: An overview of case 3 is shown in Figure 2.
case_images: PMC11362048_02
case_images: Timeline of the neurological course of cases 1-3. In all cases, the seizures ceased after neurosurgical intervention. cUS, cerebral ultrasound; MRI, magnetic resonance imaging.
case_images: fped-12-1388454-g002.jpg
case_images: PMC11362048_04_fped-12-1388454-g002.jpg
case_images: F2
case_images: An overview of case 3 is shown in Figure 2.
case_images: cUS and MRI brain findings of case 2. (A) cUS coronal view, showing a large echogenic parieto-occipital lesion at the right side, presumably extra-axial hemorrhage with midline shift to the left side. (B) MRI T2-weighted sequence, axial view, and (C) MRI T2-weighted sequence, coronal view, showing a large extra-axial hemorrhage in the parieto-occipito-temporal region on the right side with a maximal thickness of 43 mm and a midline shift of 8 mm to the left. (D) cUS coronal view, after craniotomy showing a decrease in the size of the hematoma, reduction of the midline shift and slender ventricles.
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case_images: F3
case_images: By the end of day 6, repetitive clonic movements on the left side were observed, prompting transfer to a tertiary-level NICU for neuromonitoring. cUS revealed a large echogenic right-sided parieto-occipital lesion, presumed to be extra-axial, with a midline shift to the left (Figure 3A). An urgent brain MRI confirmed the cUS findings of a large extra-axial hemorrhage in the right parieto-occipito-temporal region, with midline shift and uncal herniation (Figures 3B,C). Serial cUS over the following days showed a decrease in the size of the hematoma without rebleeding and reduction of the midline shift, with normal ventricles (Figure 3D).
case_images: PMC11362048_03
case_images: PMC11362048_04
case_images: Timeline of the neurological course of cases 1-3. In all cases, the seizures ceased after neurosurgical intervention. cUS, cerebral ultrasound; MRI, magnetic resonance imaging.
case_images: fped-12-1388454-g002.jpg
case_images: PMC11362048_04_fped-12-1388454-g002.jpg
case_images: F2
case_images: An overview of case 3 is shown in Figure 2.
case_images: cUS and MRI brain findings of case 3. (A) cUS coronal view, showing a right-sided echogenic extra-axial lesion, presumably subdural and temporally located, with midline shift. (B) MRI T2-weighted sequence, axial view, and (C) MRI T2-weighted sequence, coronal view, showing a large extra-axial hemorrhage in the temporal region on the right side with a maximal thickness of 16 mm and a midline shift of 7 mm to the left. The combined diameter of the subdural hematoma and intraparenchymal hemorrhage is 29 mm. (D) cUS coronal view, after surgical intervention.
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case_images: PMC11362048_04_fped-12-1388454-g004.jpg
case_images: F4
case_images: After intubation, she was transferred to a tertiary-level NICU. cUS revealed a large right-sided echogenic extra-axial temporal lesion, likely subdural, causing a midline shift (Figure 4A). In addition, there was right-sided subdural blood at the tentorium, as well as interhemispheric and intraventricular hemorrhage (Figures 4B,C). Serial cUS showed a reduction in hematoma size without rebleeding and resolution of the midline shift (Figure 4D).