Subpial Hemorrhage : ADistinctive Neonatal Stroke Pattern.

Abstract

Subpial hemorrhage is arare form of neonatal stroke, still poorly understood. The aim of this study was to characterize acohort of term and preterm neonates with subpial hemorrhages and contribute to abetter knowledge of this condition. Clinical records and magnetic resonance (MR) imaging data of all neonates with subpial hemorrhage followed at apediatric hospital between 2010 and 2020 were retrospectively reviewed. 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. Acharacteristic 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. Subpial hemorrhage has adistinctive 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.