1 - Department of Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
2 - Department of Neuroradiology, Hospital Dona Estefânia, Centro Hospitalar Universitario de Lisboa Central, Lisbon, Portugal
- Publicado sob a forma de poster electrónico no 59th Annual Meeting of the American Society of Neuroradiology - virtual and on-demand, 22 a 27 Maio de 2021
Purpose The present exhibition will go trough the main image findings of subpial hemorrhage in eonates, based in clinical cases from our institution. Educational objectives include: To understand the pathophysiology and presumed causative factors of this rare entity. To overview the radiologic presentation of subpial hemorrhage in neonates. To recognize the image pattern of this under-diagnosed pathology to raise awareness in the radiology community.
Materials and Methods Subpial hemorrhage has become increasingly recognized as a distinct brain hemorrhage pattern in term neonates, especially in the presence of birth trauma and coagulopathies, but also in previously healthy neonates. It is a rare form of perinatal stroke, with few reports in the literature. The purpose of this exhibit is to review the typical image findings of this rare type of neonate brain hemorrhage; to stress out the image characteristics that can lead to the diagnosis; and to discuss the physiopathology of this peculiar type of hemorrhage.
Results This educational exhibit provides an image-rich and case based discussion of imaging related to subpial hemorrhage, based on cases from our institution. After reviewing the exhibit the reader will be able to identify pertinent radiologic semiology of subpial haemorrhage in neonates.
Conclusions Subpial haemorrhage occurs between the pia-mater and the cortical surface, although its pathophysiology is not yet fully understood. Bleeding from the outermost layer of the cerebral cortex into the glia limitans is so far the best explanation for hemorrhage in this potential space. Cortical vein congestion or thrombosis is another possible mechanism. The most common finding was both intra and extra-axial hemorrhage that did not respect an arterial territory. The temporal lobe was the most affect location and pooled hemorrhage was often present, in opposition to the smoothly spread seen in typical subaracnoid bleeding). Interestingly, all hemorrhages were associated with cortical and subcortical cytotoxic edema underlying the subpial hemorrhage. Medullary vein congestion was also a common feature. In the cases available, MRA showed no abnormalities. Summary/Conclusion: Through this exhibit, neuroradiologists will gain fundamental knowledge of the key image findings of neonatal subpial hemorrhage. This knowledge is important given the distinct pattern of this hemorrhage and the scarcity of literature reviews on this topic.
Keywords: Bleeding; MRI; Neonate; Perinatal stroke; Subpial hemorrhage