title: Hyperechoic caudate nuclei: a potential mimic of germinal matrix hemorrhage.
abstract: BACKGROUND
  We have encountered bilateral hyperechoic foci in the region of the germinal matrix on cranial sonograms in neonates that have an appearance similar to germinal matrix hemorrhage (GMH), but are unusual either due to the age of the patient at presentation or to the evolution of the foci on follow-up. We believe that these findings represent hyperechoic caudate nuclei (HCN) rather than GMH.
  
  
  OBJECTIVE
  To demonstrate that bilateral HCN can be seen on cranial sonography in neonates and can mimic bilateral GMH.
  
  
  METHODS
  The cranial sonograms were reviewed in nine neonates (three term and six premature) who had HCN identified on at least one sonographic examination. CT (two patients) and MR (one patient) studies were also reviewed, as well as the neuropathological examination in one patient who died and had an autopsy. The patients' medical records were reviewed to identify any clinical markers for significant risk of perinatal ischemia.
  
  
  RESULTS
  There was clinical evidence for risk of ischemia in five of the nine neonates. All nine patients had bilateral HCN on the initial or follow-up studies. Small cysts were seen sonographically in two patients. CT was normal in one patient and revealed a small unilateral focus of increased attenuation in one infant (very small compared to the bilateral HCN). MR was normal in one patient. Histopathological examination of the brain was normal in the one patient who died and had an autopsy.
  
  
  CONCLUSIONS
  Hyperechoic caudate nuclei can occur in neonates either as a normal finding, or possibly related to ischemia, and should not always be attributed to GMH.
authors.affiliation: Department of Diagnostic Imaging, Texas Children's Hospital, 6621 Fannin St./MC2-2521, Houston, TX 77030, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Schlesinger
authors.forename: G D
authors.initials: GD
authors.lastname: Shackelford
authors.forename: L M
authors.initials: LM
authors.lastname: Adcock
mesh_terms: D002421:Caudate Nucleus / Q000000981:diagnostic imaging*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging; D008297:Male; D012189:Retrospective Studies; D014463:Ultrasonography