Bilateral Basal Ganglia Hyperintensity in Children: Symptoms and Prognosis

Pediatric brain

Hello, doctor.
My child underwent a brain ultrasound examination at birth, which showed bilateral basal ganglia hyperintensity.

1) What effects could this have? What symptoms might arise? What is the prognosis like? Until what age should we monitor this to feel reassured?
2) My child is currently two years old and is developing normally, but the anterior fontanelle has not yet closed.
Is there a correlation?
3) What could be the possible reasons for the anterior fontanelle not closing by age two? Currently, it is at 85-95%.
Is there a need for medical consultation?

Yu Er, 30~39 year old female. Ask Date: 2022/12/21

Dr. Xiao Kaiwen reply Pediatrics

1.
This is a very common report for neonatal cranial ultrasound examinations, and the vast majority are insignificant and not abnormal.
Follow-up should be conducted according to the recommendations of the pediatrician.
2 & 3.
There should be no correlation; monitor the head circumference growth curve to see if it has remained stable without significant deviation.
If there are no issues and neurological development is normal, it may simply be a normal variation without any relation.
If the fontanelles have not completely closed, it is advisable to consult a pediatric neurologist, who can perform a simple cranial ultrasound examination.

Reply Date: 2022/12/21

More Info

Bilateral basal ganglia hyperintensity observed in a child's brain ultrasound can be a concerning finding for parents, but it is essential to understand its implications, potential symptoms, prognosis, and any related developmental issues such as the closure of the anterior fontanelle.

1. Impact and Symptoms: Bilateral basal ganglia hyperintensity is often noted in neonatal brain ultrasounds and can be associated with various conditions. However, in many cases, it is a benign finding and does not indicate a significant underlying pathology. The basal ganglia are critical for motor control, and hyperintensity can sometimes suggest changes in the brain's white matter or other non-specific findings. Symptoms, if they occur, may include motor delays, coordination issues, or other neurological signs, but many children with this finding develop normally without any noticeable symptoms. The prognosis is generally favorable, especially if the child is developing normally at two years of age. Regular follow-up with a pediatric neurologist is recommended to monitor development and ensure that no new symptoms arise. The frequency of follow-up appointments can vary, but many practitioners suggest monitoring until the child is at least three years old, as this is when developmental milestones become more apparent.

2. Anterior Fontanelle Closure: The anterior fontanelle, or soft spot on a baby's head, typically closes between 9 to 18 months of age. If your child is two years old and the fontanelle has not yet closed, it is essential to monitor the head circumference and growth patterns. A persistent open fontanelle can be a normal variant, especially if the child is otherwise developing normally and has a stable head circumference growth curve. There is generally no direct correlation between bilateral basal ganglia hyperintensity and the closure of the anterior fontanelle. However, if there are concerns about head growth or neurological development, a consultation with a pediatric neurologist may be warranted.

3. Reasons for Delayed Closure of the Fontanelle: Several factors can contribute to the delayed closure of the anterior fontanelle. These include genetic factors, nutritional status, and overall health. Conditions such as hypothyroidism or increased intracranial pressure can also lead to a delayed closure, although these are less common. If your child is in the 85-95th percentile for head circumference and is otherwise healthy and developing normally, it may simply be a normal variation. However, if there are any concerns about growth patterns or neurological symptoms, it is advisable to seek medical advice. A pediatrician or neurologist can perform a thorough evaluation and may recommend imaging studies if necessary.

In summary, while bilateral basal ganglia hyperintensity can be concerning, it is often a benign finding, especially in a child who is developing normally. Regular monitoring and consultations with healthcare professionals can help ensure that any potential issues are addressed promptly. The anterior fontanelle's delayed closure may not be directly related to the hyperintensity but should be monitored for any associated growth or developmental concerns. If you have any lingering doubts or questions, do not hesitate to reach out to your child's healthcare provider for personalized guidance and reassurance.

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