Imaging of intracranial hemorrhages in infants: Usefulness of cranial ultrasonography?

Lee S, Bellamkonda Athmaram VR, Anderson JL. Infant with limpness; subdural
hemorrhage from suspected abusive head trauma. Ann Emerg Med. 2013 Jan;61(1):18,36.

“Although CT is the most common initial imaging modality of head injuries, an open anterior fontanelle in infants makes cranial ultrasonography a feasible imaging option. Ultrasonography can monitor hemorrhage size of a known intracranial bleeding event and allow continuous visualization during procedures such as subdural aspiration. [2] Needle aspiration of up to 2 mL is a suggested decompression option for infants with mild neurologic deficits as a result of small subdural hematomas or for children with subdural hemorrhage whose critical condition makes transfer to the operating room dangerous, and can obviate open decompression. [3,4]”

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Hedlund GL, Frasier LD. Neuroimaging of abusive head trauma. Forensic Sci Med
Pathol. 2009 Dec;5(4):280-90.

“Cranial sonography has utility in evaluation of the newborn and infant where it has been particularly useful in the evaluation of intracranial hemorrhage in the preterm newborn. The anterior fontanelle is a useful acoustic window for cranial ultrasonography to 6 months of age. Some clinicians will refer the infant with macrocrania for sonography evaluation as an initial imaging test. The presence of asymmetric convexity extra-axial fluid collections or extra-axial collections with complex fluid characteristics should be further investigated with MRI [22]. The use of color power Doppler may aid in the assigning of intracranial extra-axial fluid collections [23].”

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Kemp AM, Rajaram S, Mann M, et al. What neuroimaging should be performed in children in whom inflicted brain injury (iBI) is suspected? A systematic review. Clin Radiol. 2009 May; 64(5):473-83.

In an acutely ill child, the optimal imaging strategy involves initial CT, followed by early MRI and DWI if early CT examination is abnormal, or there are ongoing clinical concerns. The role of repeat CT imaging, if early MRI is performed, is unclear, as is the place for MRI/DWI if initial CT examination is normal in an otherwise well child.

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Sert A. Cranial ultrasound as a non-invasive diagnostic technique in the diagnosis of subdural haemorrhage. Arch Dis Child. 2007 May;92(5):468.

“Advanced cranial ultrasound techniques such as high resolution ultrasound and colour‐Doppler sonography may give useful prognostic information at relatively early stages following injury. Rupprecht et al concluded that high resolution ultrasound and colour‐Doppler sonography are able to reliably differentiate between subdural and subarachnoid fluid collection.4 In my opinion subdural haemorrhage can be both diagnosed and followed up by means of cranial ultrasonography (ultrasound is a reliable non‐invasive, cheap method for assessing subdural haemorrhages in infancy, especially in the newborn period). This approach might have the potential to be developed into a valid radiological assessment tool. Nevertheless, more studies are needed before any conclusion can be drawn.”

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More PubMed results on intracranial hemorrhages.

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