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The authors reviewed the cranial sonographic findings in 8 pre-term neonates, each of whom had a clinical history and neurological outcome consistent with periventricular leukomalacia (PVL). Initially, echogenic intraparenchymal lesions were identified in a distinctive distribution at the external angle of the lateral ventricles, radiating anteriorly from the trigone to the foramen of Monro to varying degree. With time, predominantly multiseptate cystic components developed. These sonographic features are different from those of periventricular or intraventricular hemorrhage.