Spontaneous Superficial Parenchymal and Leptomeningeal Hemorrhage in Term Neonates
Amy H. Huanga and
Richard L. Robertsonb
a Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School
b Department of Radiology, Children’s Hospital Medical Center and Harvard Medical School, Boston, MA
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FIG 1. Images of a neonate (patient 4) with perinatal depression and episodes of apnea beginning immediately after birth.
A, Axial view unenhanced CT scan of the head shows parenchymal hemorrhage (H) extending to the brain surface and asymmetric soft-tissue swelling (arrowheads). A minor amount of edema is present next to the hemorrhage (*). Note proximity to the pterion (arrow).
B, Axial view T2-weighted MR image (3200/85/1; echo train length, 8) shows a low intensity hemorrhage (H) with adjacent edema (arrows).
C, ADC map (2014/103/1; b max, 750 s/mm2) shows decreased diffusion in area of edema next to the hemorrhage (*).
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FIG 2. Images of a neonate (patient 3) with apnea and seizures at 24 hr of life.
A, Axial view T2-weighted MR image (3200/85/1; echo train length, 8), obtained above the level of parenchymal hemorrhage, shows soft-tissue swelling (arrowheads), subpial extension of hemorrhage (white arrows), and parenchymal edema (black arrow).
B, ADC map indicates decreased diffusion in the edematous area (arrow).
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FIG 3. Images of a neonate (patient 5) with apnea at 8 hr of life.
A, Axial view unenhanced CT scan of the head shows leptomeningeal hemorrhage (H) under an expanded squamosal suture (arrowheads). Adjacent low attenuation edema is present (arrows).
B, Axial view T2-weighted MR image (3200/85/1; echo train length, 8) shows low intensity hemorrhage (H) and high intensity adjacent edema (arrows).
C, Decreased diffusion (arrows) is indicated on the ADC map (2014/103/1; b max, 750 s/mm2).
D, Axial view T2-weighted MR image (3200/85/1; echo train length, 8), obtained at 16 months of age, shows encephalomalacia (arrows). No underlying vascular abnormality is apparent.
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FIG 4. Unenhanced CT scan of a neonate (patient 7) with seizures at 36 hr of life.
A, Brain window shows a parenchymal hemorrhage (H) extending to the brain surface in close proximity to the coronal suture (arrow). Leptomeningeal hemorrhage was evident at other levels (not shown).
B, Bone window also shows a parenchymal hemorrhage (H) extending to the brain surface in close proximity to the coronal suture (arrow).
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FIG 5. Unenhanced CT scans of a neonate (patient 6) with focal seizures at 18 hr of life.
A, CT scan shows a right parietal parenchymal hematoma (H).
B, CT scan obtained at a slightly higher anatomic section reveals additional hemorrhage (H) with extension into the sulci, indicating leptomeningeal bleeding (arrows). A large overlying cephalohematoma (arrowheads) is also present.
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