Subpial Hemorrhage of the Neonate

Abstract

Background and Purpose- Subpial hemorrhage of the neonate is a rare stroke subtype reported in few case series. Birth trauma and coagulopathy are commonly proposed etiologies. We evaluated our subpial hemorrhage of the neonate patient cohort to expand current understanding Methods- Cases of subpial hemorrhage of the neonate were identified by keyword searches of the institutional database. The medical records and magnetic resonance imagings were reviewed. Results- Seventeen cases were identified. Assisted delivery occurred in 12% of cases, and acute coagulation abnormalities occurred in 77%. Subpial hemorrhage of the neonate was located in the temporal lobe in 82%, with cytotoxic edema and medullary vein congestion and thrombosis subjacent to the hemorrhages in 100% and 76% of cases, respectively. Neurological disability was present in 44% of survivors. Three patients had chronic coagulation abnormalities. Conclusions- In our cohort, clinical findings supporting a potential relationship with birth trauma were infrequent. The imaging findings suggest a nonarterial, deep venous pattern of hemorrhagic ischemia.

Keywords: disability; hemorrhage; newborn; stroke; thrombosis; venous.

Figure 1.

A) Axial T2-weighted image demonstrates subpial hemorrhage (*) closely opposing the underlying sulci. B) Axial GRE image reveals prominence of the medullary veins within the subjacent parenchyma (→). C) Axial DWI image illustrates cytotoxic edema throughout the involved parenchyma (>).