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Did Your Newborn Suffer Cerebral
Palsy or Another Brain Injury Before
or During Labor and Delivery?

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Our Birth Brain Injury Resource Guide

the guide

Get a FREE guide of resources available throughout Ohio to children and families of children who were born with brain injuries.

Our guide can help you build a foundation of knowledge and tools that will help you help your child
now and in the future.

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Intracranial Hemorrhage - Diagnosis

Many of the symptoms of intracranial hemorrhage are quite generalized and can point to various other ailments. A headache, dizziness, confusion, or vision trouble are signs, but a newborn baby cannot convey such feelings. If a detailed examination reveals fever, irritability, or stiffness in the neck and muscles, further evaluation is often done.

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To detect bleeding, in the skull cavity or on or in the brain, the following methods may be used to diagnose the condition.

Elk & Elk

Physical Exam: Doctors will examine a baby’s reflexes, eye movement, mobility, and their ability to feel sensations. Any irregularities in breathing/heart rate or difficulties sucking or swallowing are potentially symptomatic of an intracranial bleed. Also, any signs of paralysis in the limbs can indicate a problem.

Medical scan: A computerized tomography, or CT scan, is often the first diagnostic test used to determine if there is any hemorrhaging in the skull. Brain tissue is much less dense than blood, so is not difficult to spot on the image. Plus, it is highly detailed, allowing technicians and doctors to see exactly where the bleed is. For example, the affected area may be between the meningeal layers surrounding the brain or within the ventricles or lobes of the cerebral cortex. A CT scan can find bleeding, malformed blood vessels and defects, damage due to injury, tissue swelling, and hydrocephalus, a buildup of fluid in the skull.

Magnetic Resonance Imaging, or an MRI, may be done as well. This kind of test can not only spot areas of blood, but it can also show whether the bleeding is acute or has aged to some degree. The test can spot five stages of hematoma formation, from hyperacute bleeding to hemorrhages that are a day or two, a week, or a month old.

Cerebral Angiography: A combination of X-rays and dye for contrast, this test provides a view of the blood vessels in and around the brain. It allows doctors to spot malformed blood vessels, clots, aneurysms, and other pathologies. If contrast dye is flowing out of a vessel, internal bleeding is a real possibility.

Transcranial Doppler: Sound waves are used to create detailed pictures of the brain, its structures, and blood vessels. The flow of blood can be measured in real time. In addition to showing the movement of blood and whether it is leaking out of the vessels, it can also be used to monitor other conditions that can exacerbate the problem.

Platelet Count: Helping the blood to clot, platelets can reveal whether bleeding is present or there is an elevated risk for it. A low count with thrombocytopenia may put an infant at risk for an intracranial bleed. Technicians can evaluate the size, number, and health of platelets, which can be major factors in not just the risk for, but the potential outcome of a crisis. If platelet counts are low, it’s going to be harder for a skull cavity bleed to stop on its own.

Bleeding Time: Doctors can use this blood test to examine how quickly one stops bleeding. It usually involves a small cut on the lower arm, with a blood pressure cuff inflated at the upper arm. The time for the bleeding to stop is then tracked. Normally, it should clot up in one to nine minutes, but irregular results can indicate a variety of problems, including the risk of intracranial hemorrhaging.

Other tests that can identify bleeding within the skull include those for kidney and liver function. A complete blood count can be used along with the results of other tests to make a conclusive diagnosis. The risk of intracranial hemorrhage is higher with disorders such as decreased platelets, hemophilia, leukemia, sickle cell anemia, liver disease, and other conditions, so the diagnosis of these may give doctors a reason to be on the lookout for bleeding inside a baby’s head. Those at risk include premature infants. Hemorrhagic conditions typically occur quickly, within the first day after birth, so one can be cautious by checking for any evidence of, for example, ventricular bleeding.

A quick diagnosis can help hasten treatment. The outlook varies usually based on the size and location of the area affected, and how much blood gets into the brain. Still, variables include some loss of brain function or even death even if medical treatment is prompt.