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Subarachnoid Hemorrhage – Diagnosis

Subarachnoid hemorrhage is found when bleeding occurs in the area between the brain and the thin tissues that cover it. This is the space known as the subarachnoid area. Even infants can experience bleeding on the brain.

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Symptoms of a Hemorrhage in Newborn Babies

The symptoms of a subarachnoid hemorrhage will vary based on the severity of the bleeding. Infants who experience this kind of hemorrhage may exhibit one or more of the following symptoms and signs:

Elk & Elk
  • Irritability
  • Apnea
  • Lethargy
  • Feeding difficulties
  • Neonatal seizures
  • Altered tone
  • Strained or shallow breathing
  • Altered levels of consciousness

It is usually recommended that babies who are born prematurely ought to receive a routine ultrasound between seven and fourteen days old, with another ultrasound done at the newborns’ original due date. Typically, additional ultrasounds will be ordered if a premature newborn baby displays any of the symptoms or signs, particularly if the baby’s health suddenly takes a turn for the worse. It is estimated that an ultrasound may detect problems requiring further follow-up in around 30 percent of babies who are born before 24 weeks gestation.

How Is a Diagnosis of a Hemorrhage Made?

When a baby begins to display the signs and symptoms of a subarachnoid hemorrhage, the doctors will learn as much as they can about those symptoms, as well as delving into the family’s medical history, and conducting a physical examination.

There are diagnostic tests that can help doctors determine where the bleeding is coming from, such as:

  • Magnetic resonance imaging – more commonly known as an MRI scan, this is a noninvasive test that makes use of radio-frequency and magnetic field waves to give doctors a detailed view of the soft tissues of the brain. The test examines the blood vessels and the structures of the brain to determine the source of the bleeding.
  • Computed Tomography – a CT scan is a noninvasive X-ray that will give physicians detailed images of the brain’s anatomical structures. This type of test is particularly useful to detect blood around and in the brain. There is a new technology, known as CT angiography (CTA) which involves an injection of contrast into the blood stream to view the brain’s arteries. CTA tests offer the best picture of the blood vessels and soft tissues. CT scans tend to be discouraged as the radiation can have an effect on the immature central nervous system in babies.

Preterm Babies

Many premature babies are diagnosed with a subarachnoid hemorrhage within the first day of their life, with around 90 percent being diagnosed in the first four days. The hemorrhage can be diagnosed on routine screening, but there are cases that present rapidly, and others that present slowly.

Rapidly presenting cases usually involve a large hemorrhage, and the infant will have altered states of consciousness, metabolic abnormalities, and abnormal findings during a neurological examination. The baby may even have seizures. In such cases, an ultrasound can be used to assess vascular flow. An MRI scan will be able to detect smaller lesions and hemorrhages. Near-infrared spectroscopy, or NIRS, has also become popular for monitoring the flow of oxygen and blood. This method is low-cost and noninvasive for babies.

Full-Term Babies

Most infants with a subarachnoid hemorrhage do not display clinical signs and symptoms. Those babies who do display clinical symptoms often present with several neurologic symptoms, either in combination or singly. The symptoms include:

  • Generalized hypotonia
  • A decreased level of consciousness
  • Seizures

The symptoms tend to vary according to the kind of hemorrhage, and it can be difficult to differentiate clinically between different kinds of brain lesions. That is why it is important for physicians to obtain a detailed history so as to assess risk factors and decide on the appropriate interventions.

Cranial ultrasonography is popularly used in full-term infants to diagnose bleeding on the brain. This method can be used to visualize hemorrhagic and ischemic lesions, and even choroid plexus abnormalities and ventricular enlargement. However, CT scans tend to offer a better resolution can help to diagnose subarachnoid hemorrhages in newborn babies.

It is important that physicians act quickly once they have identified the hemorrhage. A popular remedy used is cooling therapy where the baby’s core temperature is cooled to restrict blood vessels, slow the metabolic rate, and try to stop the bleeding.