American Journal of EEG Technology

ISSN: 0002-9238 (Print) 2375-8600 (Online) Journal homepage: https://www.tandfonline.com/loi/utnj18

A Brief Introduction to Echoencephalography

Joseph J. Belluomini

To cite this article: Joseph J. Belluomini (1965) A Brief Introduction to Echoencephalography,

American Journal of EEG Technology, 5:2, 23-25, DOI: 10.1080/00029238.1965.11080643

To link to this article: https://doi.org/10.1080/00029238.1965.11080643

Published online: 23 Feb 2015.

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 AMERICAN JOURNAL OF EEG TECHNOLOGY
VOL. 5, NO. 2, PAGES 23-25, 1965
Printed and Published in the United States of America

A BRIEF INTRODUCTION TO ECHOENCEPHALOGRAPHY

JOSEPH J. BELLUOMINI
Neurophysiology Laboratory
Baptist Memorial Hospital, Memphis, Tennessee
Reprinted by permission from The Delta Recorder

I. INTRODUCTION
Echoencephalography is a recently developed technique using pulsed
ultra sound to determine the position of the midline structures of the brain.
It is finding a niche in radiology and electroencephalography as a valuable
adjunct to both procedures. It is hoped that this short paper .will help you
as EEG Technicians to understand this new technique better and perhaps
challenge you to find out more about it.
II. PRINCIPLE
The principle is the same used by the military in submarine detection
(sonar) and by commercial companies in the detection of cracks and flaws
in metal components. In echoencephalography this pulsed ultrasound is trans-
mitted by a crystal through the temporal bone of the skull and the brain.
An echo or reflected signal is produced whenever there is a change in the
density of the transmitting media. When the echo of the transmitted pulse is
from a plane that is perpendicular to the face of the probe, it is reflected
back to the transmitting crystal. This crystal or probe acts as a receiver
· between transmissions. The crystal or probe picks up these. echoes and they
are amplified and displayed on a cathode ray tube as vertical spikes.
The distance between the transducer and any difference of density
within the transmitting media (brain) can be accurately measured if the ultra-
sonic frequency and the transmitting media are known.
III. DEFINITIONS
Listed below are a few terms that may be unfamiliar to you.
( 1). ACOUSTICAL IMPEDANCE: The degree of resistance to the trans-
mitted sound wave of any given substance. The intensity of the echo depends
on the difference in acoustic impedance of two adjoining media.
(2). CRYSTAL ARTEFACf OR MAIN BANG: This is the initial vertical
spike seen on the left hand side of the cathode ray tube, A and A' in figure 1.
It consists of transmitted pulses and echoes from the near skull wall and
brain.
(3). MIDLINE SPIKE: (B and B' in figure 1). Thought to be produced by
the pineal gland, septum pellucidum and other structures. The third ventricle
can also be outlined producing a pair of midline spikes from 2-6 mm. apart.
(4). FAR SIDE SIGNATURE OR FAR WALL SIGNATURE: This is
the group of echoes from the far side of the head. It consists of echoes from
the brain meninges interface, inner table of the skull, outer skull table and
skin to air interface. Figure I. C and C'.
Presented at the meeting of the Southern Society of EEG Technologists, November 14, 1964,
at Memphis, Tennessee .

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 A BRIEF INTRODUCTION TO ECHOENCEPHALOGRAPHY

FIGURE 1.
The top trace is with the transducer held to the right side of the head . The bottom trace
is with the transducer held to the left side of the head. A is the main bang, B is the
midline spike, and C is the far wall signature.

(5). ULTRA SONIC. Sound waves of such high frequency as to be inaudible

to human ear.
(6). SONO-GRAM: Echogram.
IV. TECHNIQUE
The hand held transducer which is both transmitter and receiver, is
held against the temporal bone in the region above the ear. The area should
be coated with an oil or water for good transmission of the ultra sound.
The probe is moved gently and rocked slightly until the far side signature
and midline spikes are obtained. The far side signature and midline spikes must
be obtained at the same time. After a photograph is taken, the probe is
moved to the left side of the head and the same procedure is employed until
again the far side signature and midline spikes are obtained. A double expo-
sure is made so that both determinations will be on the same photograph, fig-
ure 1.
The test is quick, 3-5 minutes, atraumatic, the average ultra sonic
power levels used are approximately one-one thousandth to one-one mil-
lionth of the power used for therapeutic or destructive purposes and the re-
sults are available immediately. The apparatus is light and mounted on a
movable cart for easy portability.

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 AMERICAN JOURNAL OF EEG TECHNOLOGY

The same ap_paratus can be used to determine the size of the lateral
ventricles in the brain, measure the bi-parietal diameter of the fetal head
in-utero, localizing renal calculi anJ study of the heart motion.

V. INTERPRETATION
The midline spike should be in the same position on the upper trace
and the lower trace in a normal echoencephalogram . A shift of the midline
spike to the right or left of less than 3 mm . is not considered to be clinically
significant in the adult.
Figure 2 shows a midline shift of 9 mm . to the left.
R-L

L-R

FIGURE 2.
A midline shift of 9 mm to the left. The small markers are 2 mm apart. The larger
markers are 10 mm apart.

VI. SUMMARY
A brief description of the principle and technique of echoencephalo-
graphy alone with a few definitions are presented.

REFERENCES
EKOLINE 20 MANUAL
EKOLINE BULLETIN #3, JANUARY 1964
EKOLINE BULLETIN #8 . JUNE / JULY 1964

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