Hypotonic neonates suspected to have a traumatic brain injury should have an MRI or CT of the brain. In neonates with traumatic brain injury, MRI or CT may show evidence of intracranial bleeding, cerebral contusion, or both (Figure 108.1). Intracranial blood may be found in the epidural, subdural, or arachnoid spaces; parenchyma; or ventricles. Epidural hematoma refers to blood between the inner surface of the bone and the periosteum. Epidural hematomas are confined to the individual bone because the blood collection is restricted by the periosteum attachment to each bone. They appear as convex masses on neuroimaging studies (Figure 108.1 [A]). The blood does not enter into the sulci or fissures of the brain. Subdural hematoma refers to blood between the dura and the arachnoid. The hematoma is not confined to an individual bone. The subdural hematoma collection appears as a concave mass on imaging studies. The blood does not enter into the sulci or fissures of the brain in neonates with epidural and subdural hematomas.

Figure 108.1.—[A] Epidural bleeding, small intraparenchymal bleed on the opposite frontal hemisphere. [B] Intraventricular hemorrhage around the ventricles, intraparenchymal blood, and cerebromalacia in the right occipital lobes. [C] Intraventricular blood in the occipital horns of the lateral ventricles.