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Implications for practice

  • In an acutely ill child, a computerised tomography scan (CT) is the preferred imaging technique, due to its:
    • widespread availability
    • ability to identify and localise acute extra-axial bleeding
  • If the CT is abnormal or there are ongoing clinical concerns, magnetic resonance imaging (MRI) with diffusion weighted imaging (DWI) should be performed since it has the capacity to identify further features and identify intracranial changes.  Centres experienced in magnetic resonance scanning are increasingly offering MRI as first line investigation
  • Ultrasound scanning should never be used as a diagnostic investigation since, whilst it found some features, it missed many others.  High resolution ultrasound scans (USS) may have some advantage as a secondary investigation in experienced hands to monitor or follow the development of a lesion already identified on CT or MRI


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