High-resolution cranial ultrasound in the shaken-baby syndrome

With limited near-field resolution and accessible acoustic windows, sonogra phy has not been advocated for assessing central nervous system injuries in the shaken-baby syndrome. Our purpose was to correlate high-resolution ult rasonographic characteristics of central nervous system injuries in whiplas h injuries and the shaken-baby-syndrome with MRI and CT. Ultrasonographic i mages of 13 infants, aged 2-12 months, with whiplash or shaking cranial tra uma were reviewed and compared with MRI in 10 and CT in 10. Five patients h ad serial ultrasonography and MRI or CT follow-up from 1 to 4 months after the initial injury. With ultrasonography we identified 20 subdural haematom as. MRI and CT in 15 of these showed that four were hyperechoic in the acut e stage, three were mildly echogenic in the subacute stage, and that one su bacute and seven chronic lesions were echo-free. Five patients had acute fo cal or diffuse echogenic cortical oedema which evolved into subacute subcor tical hyperechoic haemorrhage in four, and well-defined chronic sonolucent cystic or noncystic encephalomalacia was seen at follow-up in two. Using ul trasonography we were unable to detect two posterior cranial fossa subdural haematomas or subarachnoid haemorrhage in the basal cisterns in three case s, but did show blood in the interhemispheric cistern and convexity sulci i n two. Ultrasonography has limitations in demonstrating abnormalities remot e from the high cerebral convexities but may be a useful adjunct to CT and MRI in monitoring the progression of central nervous system injuries in inf ants receiving intensive care.