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IST(~RICALLY, the diagnosis of neonatal intracranial hemorrhage (ICH) has been made either at autopsy' or after the sudden, catastrophic, clinical deterioration of a critically ill infant.' Recent technical advances in intracranial imaging techniques represent a significant improvement in the clinician's ability to diagnose neonatal ICH.3.4 With the introduction of computerized tomography (CT), both the diagnosis and localization of ICH have been greatly simplified.-' The development of two-dimensional ultrasonography further enhances this capability.4.5Although cranial ultrasound has become a frequently used diagnostic tool in premature infants,4-8 its application in the full-term infant has received less attention. We have recently encountered an otherwise healthy term infant who presented with only subtly suggestive clinical findings: a single episode of apnea on the first day of life and mild episodes of bradycardia. During diagnostic evaluation, two-dimensional ultrasonography revealed an extensive intracranial hemorrhage. Neither the history nor physical examination suggested a lesion of the magnitude found on ultrasound examination.Transfontanel cranial ultrasonography is a relatively simple, noninvasive procedure. As our experience with this infant suggests, it may be helpful in evaluating the full-term infant for suspected central nervous system pathology. Case ReportThe patient was a 3650-gram male infant born, after a 40-week gestation, by spontaneous vaginal delivery to a 23-year-old primagravida woman. The pregnancy, labor, and delivery were uncomplicated. Apgar scores were 8 and 9 at I and 5 minutes, respectively. Routine Vitamin K (I mg 1M) was ad-ministered in the delivery room. The initial physical and neurologic examinations were normal. At 6 hours of age, the infant suddenly became cyanotic with no visible respiratory effort. Vigorous tactile stimulation and administration of oxygen by facemask led to a prompt return of normal color and good respiratory effort. The entire episode lasted less than 60 seconds. No further ventilatory support was needed.A diagnostic evaluation was begun at the local level I hospital. Serum electrolytes revealed a sodium of 137 mEq/l, potassium 4.1 mEq/1, and chloride 103 mEq/1. The BUN was 22 mg/dl and the glucose 97 mg/ dl. Cultures of the blood, urine, and cerebrospinal fluid (ultimately reported as no bacterial growth) were obtained. The lumbar puncture produced grossly bloody spinal fluid; protein and glucose were not recorded. No organisms were seen on Gram stain. Parenteral ampicillin (100 mg/kg/day) and gentamicin (5 mg/kg/day) were started. The infant was transferred to Madigan Army Medical Center (MAMC) Neonatal Intensive Care Unit for further evaluation.Upon arrival at MAMC, a small right cephalohematoma was the only notable physical finding. A complete neurologic examination was normal. Serial examinations during the infant's hospitalization failed to demonstrate any focal neurologic signs. Arterial blood gases and serum calcium were normal. No fracture...

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