Subpial Hemorrhage of the Neonate

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.

Angiographic extravasation of contrast medium in acute traumatic subdural hematoma from arterial rupture

✓ Carotid angiography of a patient with suspected subdural hematoma showed extravasation of the contrast medium from an ascending branch of the middle cerebral artery. The leak was verified at operation. There was no visual evidence of an aneurysm, angioma, subarachnoid or subpial hemorrhage.