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Subpial Hemorrhage

A Distinctive Neonatal Stroke Pattern

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Abstract

Background and Purpose

Subpial hemorrhage is a rare form of neonatal stroke, still poorly understood. The aim of this study was to characterize a cohort of term and preterm neonates with subpial hemorrhages and contribute to a better knowledge of this condition.

Material and Methods

Clinical records and magnetic resonance (MR) imaging data of all neonates with subpial hemorrhage followed at a pediatric hospital between 2010 and 2020 were retrospectively reviewed.

Results

A total of 10 patients were included in the analysis, 40% of whom were term neonates. Operative vaginal delivery was registered in 30%. Temporal was the most common location of subpial hemorrhage (70%), and all patients displayed underlying brain infarction. A characteristic yin-yang pattern was present in 90% of the study cohort, and ingurgitation of medullary veins on susceptibility weighted imaging in 80%. Cerebellar microbleeds were observed in 60% of neonates, both term and preterm. When available, MR angiography and venography were unremarkable. Patients’ clinical outcome was variable, with early prematurity not associated to worse outcomes.

Conclusion

Subpial hemorrhage has a distinctive MR pattern, with underlying parenchymal venous infarction, and can occur in term and preterm neonates. This study results suggest an association between subpial hemorrhage and cerebellar microbleeds but further studies are required to confirm it and better understand the pathophysiology of subpial hemorrhage.

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References

  1. Dunbar M, Kirton A. Perinatal stroke: mechanisms, management, and outcomes of early cerebrovascular brain injury. Lancet Child Adolesc Health. 2018;2:666–76.

    Article  Google Scholar 

  2. Friede RL. Subpial hemorrhage in infants. J Neuropathol Exp Neurol. 1972;31:548–56.

    Article  CAS  Google Scholar 

  3. Huang AH, Robertson RL. Spontaneous superficial parenchymal and leptomeningeal hemorrhage in term neonates. AJNR Am J Neuroradiol. 2004;25:469–75. Erratum in: AJNR Am J Neuroradiol. 2004;35:666.

    Google Scholar 

  4. Lee S, Mirsky DM, Beslow LA, Amlie-Lefond C, Danehy AR, Lehman L, Stence NV, Vossough A, Wintermark M, Rivkin MJ; International Paediatric Stroke Study Neuroimaging Consortium and the Paediatric Stroke Neuroimaging Consortium. Pathways for Neuroimaging of Neonatal Stroke. Pediatr Neurol. 2017;69:37–48.

    Article  Google Scholar 

  5. Cain DW, Dingman AL, Armstrong J, Stence NV, Jensen AM, Mirsky DM. Subpial Hemorrhage of the Neonate. Stroke. 2020;51:315–8.

    Article  Google Scholar 

  6. Assis Z, Kirton A, Pauranik A, Sherriff M, Wei XC. Idiopathic Neonatal Subpial Hemorrhage with Underlying Cerebral Infarct: Imaging Features and Clinical Outcome. AJNR Am J Neuroradiol. 2021;42:185–93.

    Article  CAS  Google Scholar 

  7. Cole L, Dewey D, Letourneau N, Kaplan BJ, Chaput K, Gallagher C, Hodge J, Floer A, Kirton A. Clinical Characteristics, Risk Factors, and Outcomes Associated With Neonatal Hemorrhagic Stroke: A Population-Based Case-Control Study. JAMA Pediatr. 2017;171:230–8. Erratum in: JAMA Pediatr. 2017;171:602.

    Article  Google Scholar 

  8. Bergman I, Bauer RE, Barmada MA, Latchaw RE, Taylor HG, David R, Painter MJ. Intracerebral hemorrhage in the full-term neonatal infant. Pediatrics. 1985;75:488–96.

    Article  CAS  Google Scholar 

  9. Hanigan WC, Powell FC, Palagallo G, Miller TC. Lobar hemorrhages in full-term neonates. Childs Nerv Syst. 1995;11:276–80.

    Article  CAS  Google Scholar 

  10. Slaughter L, Egelhoff J, Balmakund T. Neurologic outcome in neonatal temporal lobe hemorrhagic venous infarcts. J Child Neurol. 2009;24:1236–42.

    Article  Google Scholar 

  11. Bruno CJ, Beslow LA, Witmer CM, Vossough A, Jordan LC, Zelonis S, Licht DJ, Ichord RN, Smith SE. Haemorrhagic stroke in term and late preterm neonates. Arch Dis Child Fetal Neonatal Ed. 2014;99:F48–53.

    Article  Google Scholar 

  12. Kersbergen KJ, Groenendaal F, Benders MJ, de Vries LS. Neonatal cerebral sinovenous thrombosis: neuroimaging and long-term follow-up. J Child Neurol. 2011;26:1111–20.

    Article  Google Scholar 

  13. Khalatbari H, Wright JN, Ishak GE, Perez FA, Amlie-Lefond CM, Shaw DWW. Deep medullary vein engorgement and superficial medullary vein engorgement: two patterns of perinatal venous stroke. Pediatr Radiol. 2021;51:675–85.

    Article  Google Scholar 

  14. Barreto ARF, Carrasco M, Dabrowski AK, Sun LR, Tekes A. Subpial Hemorrhage in Neonates: What Radiologists Need to Know. AJR Am J Roentgenol. 2021;216:1056–65.

    Article  Google Scholar 

  15. Villamor-Martinez E, Fumagalli M, Alomar YI, Passera S, Cavallaro G, Mosca F, Villamor E. Cerebellar Hemorrhage in Preterm Infants: A Meta-Analysis on Risk Factors and Neurodevelopmental Outcome. Front Physiol. 2019;10:800.

    Article  Google Scholar 

  16. Limperopoulos C, du Plessis AJ. Disorders of cerebellar growth and development. Curr Opin Pediatr. 2006;18:621–7.

    Article  Google Scholar 

  17. Johnsen SD, Tarby TJ, Lewis KS, Bird R, Prenger E. Cerebellar infarction: an unrecognized complication of very low birthweight. J Child Neurol. 2002;17:320–4.

    Article  Google Scholar 

  18. Limperopoulos C, Benson CB, Bassan H, Disalvo DN, Kinnamon DD, Moore M, Ringer SA, Volpe JJ, du Plessis AJ. Cerebellar hemorrhage in the preterm infant: ultrasonographic findings and risk factors. Pediatrics. 2005;116:717–24.

    Article  Google Scholar 

  19. Volpe JJ. Cerebellum of the premature infant: rapidly developing, vulnerable, clinically important. J Child Neurol. 2009;24:1085–104.

    Article  Google Scholar 

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Funding

No funds, grants, or other support were received.

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Authors and Affiliations

  1. Neuroradiology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal

    Catarina Pinto

  2. Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal

    Bruno Cunha

  3. Functional Area of Neuroradiology, Medical Imaging Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal

    Mafalda Mendes Pinto

  4. Neuroradiology Department, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal

    Carla Conceição

Authors
  1. Catarina Pinto
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  2. Bruno Cunha
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  3. Mafalda Mendes Pinto
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  4. Carla Conceição
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Corresponding author

Correspondence to Catarina Pinto.

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Conflict of interest

C. Pinto, B. Cunha, M.M. Pinto and C. Conceição declare that they have no competing interests.

Ethical standards

This retrospective study was performed after consultation with the institutional ethics committee and in accordance with national legal requirements. This study was approved by local Ethics Committee. Consent to participate: Informed consent was waived. Consent for publication: Informed consent was waived.

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Pinto, C., Cunha, B., Pinto, M.M. et al. Subpial Hemorrhage. Clin Neuroradiol 32, 1057–1065 (2022). https://doi.org/10.1007/s00062-022-01149-y

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  • DOI: https://doi.org/10.1007/s00062-022-01149-y

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