ECHODENSE SPINAL SUBARACHNOID SPACE IN NEONATES WITH PROGRESSIVE VENTRICULAR DILATATION - A MARKER OF NONCOMMUNICATING HYDROCEPHALUS

OBJECTIVE. Our purpose was to evaluate the frequency and clinical sign ificance of echogenic debris in the spinal subarachnoid space of neona tes at risk for progressive ventricular dilatation. SUBJECTS AND METHO DS. Spinal sonography was performed on 15 neonates with severe intracr anial hemorrhage (n = 10) or bacterial meningitis (n = 5). Spinal sono graphy also was performed on 16 control neonates. Images were analyzed for the presence and location of echogenic debris within the thoracol umbar subarachnoid space. Lumbar punctures were performed on all 31 ne onates, and CSF was analyzed for cell count and protein content. Ten o f 15 neonates required ventricular drainage procedures. RESULTS. Progr essive ventricular dilatation occurred in 11 of 15 neonates with intra cranial hemorrhage or meningitis. Echogenic debris was present in the thoracolumbar subarachnoid space on spinal sonography in every neonate with progressive ventricular dilatation compared with none of the 16 control neonates (p <.0001 by chi-square analysis). In addition, the 1 1 neonates with echogenic subarachnoid space had significantly higher protein and RBC contents in the lumbar CSF (p <.04). CONCLUSION. Echog enic subarachnoid space revealed by sonography is associated with prog ressive ventricular dilatation after severe intracranial hemorrhage or bacterial meningitis and is caused by high protein and RBC contents i n the subarachnoid space. This finding may be helpful in identifying n eonates who will not benefit from serial lumbar punctures for treatmen t of hydrocephalus.