A cranial CT scan reveals a small subarachnoid hemorrhage. The housestaff wishes to know if these findings adequately explain the infants symptomatology. Symptoms attributed to intracranial blood include seizures, apnea, cyanotic spells, irritability, poor feeding, lethargy, paleness and bulging fontanelle. Since the incidence of ICH was higher in studies which looked at symptomatic patients than in those looking at asymptomatic patients, this provides indirect evidence that findings of ICH in symptomatic patients correctly identify the ICH as the cause of these symptoms in at least some patients.
Further study is warranted.
No study has determined the incidence of intracranial bleeding in all newborns, and compared how many are symptomatic vs. asymptomatic. All bleeds observed were periventricular, no epidural, subdural or subarachnoid hemorrhages were seen. Of the nine cases of ICH listed, four were intraventricular, two were thalamic, and there was one each of primary parenchymal, subarachnoid and subdural hemorrhage. 3 CT scans may be able to identify cases of ICH missed with cranial ultrasound. In 58 full-term newborns with uncomplicated deliveries and negative cranial ultrasound examinations, CT scans demonstrated abnormalities in all cases, including high densities in the interhemispheric fissure, around the sagittal sinus, sigmoid sinus, tentorium and in the quadrigerminal cistern.