Neonatal subpial hemorrhage: clinical presentation, neuroimaging findings and outcome.

IF 2.4 3区医学 Q2 CLINICAL NEUROLOGY Neuroradiology Pub Date : 2025-03-17 DOI:10.1007/s00234-025-03589-y

Andres Server, Anna Latysheva, Bård Nedregaard, Arild Erland Rønnestad, Pål Bache Marthinsen

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Abstract

Purpose: Subpial hemorrhage is a rare form of intracranial hemorrhage (ICH) in neonates that remains underreported and inadequately understood. The aim of this study is to characterize the neuroimaging patterns of subpial hemorrhage, assess changes in the underlying brain parenchyma, and examine its clinical features and outcomes.

Methods: We reviewed the medical records and neuroimaging data of neonates with subpial hemorrhage admitted to our hospital between January 2010 and December 2023. Cases of subpial hemorrhages were identified through keywords searches within the hospital´s electronic database.

Results: Twenty-eight patients were included in this retrospective study, 82% of whom were born at term. The most common clinical indication for imaging was a combination of apneas and seizures, ocurring in 50%. Hematologic abnormalities were present in 58% of patients. Magnetic resonance imaging (MRI) was performed acutely at the time of presentation between days 1 and 9 of life in 85% of cases. Subpial hemorrhages were unilateral in 86% of neonates, most commonly located in the temporal lobe (44%), and associated with other type of intracranial hemorrhage in 96% of cases, most often parenchymal (86%) and subdural (64%) hemorrhages. We identified three imaging patterns of subpial hemorrhage and two patterns of changes in the underlying brain parenchyma. Additionally, the hyperintense pia mater sign (HPm-sign) was observed on time-of-flight MR angiography (TOF-MRA) in 12 of 18 patients. Neurologic sequelae were noted in 28% of survivors.

Conclusion: Subpial hemorrhage has a distinctive MR pattern, often accompanied with cortical infarction and in most cases underlying parenchymal hemorrhage. In this study, we identified the HPm-sign that may be used to differentiate subpial hemorrhage from other types of hemorrhages. Additionally, we found a correlation between prominent medullary veins (PMV) and intraparenchymal hemorrhage (IPH).

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目的：颅底出血是新生儿颅内出血（ICH）的一种罕见形式，目前仍未得到充分报道和了解。本研究旨在描述颅底下出血的神经影像学模式，评估下层脑实质的变化，并研究其临床特征和预后：方法：我们回顾了 2010 年 1 月至 2023 年 12 月期间我院收治的头皮下出血新生儿的病历和神经影像学资料。通过在医院电子数据库中进行关键词搜索，确定了皮下出血病例：这项回顾性研究共纳入 28 例患者，其中 82% 为足月儿。最常见的造影临床指征是呼吸暂停和癫痫发作，占 50%。58%的患者存在血液异常。85%的病例在出生后第1天至第9天发病时立即进行了磁共振成像（MRI）检查。86%的新生儿为单侧皮下出血，最常见的位置是颞叶（44%），96%的病例伴有其他类型的颅内出血，最常见的是实质出血（86%）和硬膜下出血（64%）。我们确定了三种硬膜下出血的成像模式和两种底层脑实质的变化模式。此外，18 例患者中有 12 例在飞行时间磁共振血管造影（TOF-MRA）中观察到高张力桥膜征（HPm-sign）。28%的幸存者出现了神经系统后遗症：结论：皮质下出血具有独特的磁共振成像模式，通常伴有皮质梗死，在大多数病例中还伴有潜在的实质出血。在这项研究中，我们发现了 HPm 信号，它可用于区分皮质下出血和其他类型的出血。此外，我们还发现突出的髓质静脉（PMV）与实质内出血（IPH）之间存在相关性。

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来源期刊

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.