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I read with interest the article by Datta et al who undertook a retrospective analysis of 74 patients under the age of 2 years with subdural haemorrhage or subdural effusion diagnosed between 1992 and 2001.1 The authors wrote that ultrasound was performed before computed tomography in 12 cases and that subdural haemorrhages were not seen in seven of these 12 cases. However, the ages of the patients in whom ultrasound was performed were not given. Datta et al suggested that ultrasound has no role in excluding a subdural haemorrhage, even in experienced hands, but may be used to monitor resolution of subdural haemorrhage diagnosed on computed tomography/magnetic resonance imaging and to look for subtle shearing lesions at the grey–white interface. However, such a generalisation about the capacity of cranial ultrasound may not be not valid because the numbers of the patients in their retrospective study were few and the mean ages of patient groups are important for choosing the imaging technique.
On the other hand, in an epidemiological study by Hobbs et al, the definition used was “any child under 2 years at diagnosis with subdural haemorrhage, haematoma, or effusion of any severity, arising from whatever cause and diagnosed on computed tomography, magnetic resonance imaging, or ultrasound scan or at postmortem examination”. This was the largest study of subdural haemorrhage in infancy in the UK2 and stated that cranial ultrasound scan was used for the diagnosis of subdural haemorrhage.
However, Gaevyi et al examined 275 children with acute craniocerebral trauma and said that various types of intracranial haemorrhages and contusions of the brain were differentiated by means of cranial ultrasonography. They concluded that cranial ultrasonography is a highly informative diagnostic method, particularly in infancy, which makes it possible to visualise craniocerebral injuries and study them continuously during treatment. Intraoperative ultrasound was conducted in older children with suspected intracranial haematoma, which allowed the pathological process to be clearly located.3
Advanced cranial ultrasound techniques such as high resolution ultrasound and colour‐Doppler sonography may give useful prognostic information at relatively early stages following injury. Rupprecht et al concluded that high resolution ultrasound and colour‐Doppler sonography are able to reliably differentiate between subdural and subarachnoid fluid collection.4 In my opinion subdural haemorrhage can be both diagnosed and followed up by means of cranial ultrasonography (ultrasound is a reliable non‐invasive, cheap method for assessing subdural haemorrhages in infancy, especially in the newborn period). This approach might have the potential to be developed into a valid radiological assessment tool. Nevertheless, more studies are needed before any conclusion can be drawn.
Competing interests: None declared.