CT demonstration of intracranial bleeding in term newborns with mild clinical symptoms.
This paper presents symptomatic term newborns with negative ultrasound examination which showed intracranial bleeding demonstrated by CT scan. Fifty-eight term newborns with Apgars of 9-10 were referred for repeat CT examination of the brain with symptoms, such as apnea, disturbances of swallowing or sucking, impaired muscular tonus, tremor and jerks. The ultrasound examination in all was normal. The first CT scan was performed 12-13 h after delivery. The second CT scan was performed at least two weeks later. Twenty-three of the patients underwent lumbar puncture. Physical examination was performed on each patient--at birth and one week later. The clinical symptoms were still present at the time of the second physical examination. Fourteen to seventeen months following the delivery, the psychomotor development was evaluated in 29 of the children using the Gesell test. In five children, the diagnosis of psychomotor retardation was established which correlated with the brain atrophy demonstrated on CT. Twenty-three newborns who underwent lumbar puncture showed evidence of bleeding into the subarachnoid space. The blood haemoglobin levels of all the cases was below 18 g/dl. The first CT examination demonstrated blood in the subarachnoid space. The second CT scan did not demonstrate any findings. Intracranial bleeding in newborns may be associated with normal delivery. The demonstration of high densities in the first CT scan, the normal second CT scan, the blood tinged or xantochromic CSF and the normal blood haemoglobin levels are indicative of intracranial bleeding.
Department of Radiology, E. Wolfson Medical Center, Holon, Israel.
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Avrahami
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Amzel
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Katz
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Frishman
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Osviatzov
D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging*; D002658:Developmental Disabilities / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D011596:Psychomotor Disorders / Q000209:etiology; D014057:Tomography, X-Ray Computed